bluuebunny/crossref_metadata_2025 huggingface dataset:
Healthcare resource utilization, quality metrics, and costs of bladder cancer within the oncology care model.
Authors: Blakely L. Johnetta , Hepp Zsolt , Fuldeore Rupali , Tomicki Samantha , Hirsch Jared , Dieguez Gabriela , Wirtz Heidi
Published: September 2021

54

Background: The Oncology Care Model (OCM) incentivizes practices to provide higher quality, lower cost care for Medicare beneficiaries through payment arrangements that include financial and performance accountability for 6-month care episodes. We sought to describe the existing experience with bladder cancer (BC) for OCM practices, in the context of all OCM cancer types, given the dynamic treatment landscape in which new and emerging therapies will impact spending and patient care in this payment model. Objective: To estimate healthcare resource utilization (HRU), OCM quality metrics, and costs for OCM episodes among Medicare beneficiaries with BC. Methods: OCM episodes triggered by receipt of cancer therapy (index event) were identified among Medicare beneficiaries (100% Research Identifiable Files) from 2016-18. Other inclusion criteria were enrollment in Parts A & B for the entire OCM episode (6 months or until death) and 6 months pre-index date, Medicare as primary payer, and ≥1 qualifying Evaluation & Management visit during the episode. A cancer type was assigned to each episode. BC episodes were stratified as low- (defined by receipt of BCG and/or mitomycin without other systemic therapy) or high-risk (receipt of systemic therapy other than BCG or mitomycin) based on OCM definitions. Results: Of the 2.2 million OCM cancer episodes identified among 1 million beneficiaries, 60,099 (̃3%) were BC episodes. Our analytic cohort consisted of 43,621 BC episodes (69% low-risk and 31% high-risk) among 33,497 beneficiaries. Across BC episodes, average patient age was 76.6 years and 77% were male. Relative to low-risk episodes, high-risk episodes included higher metastatic cases (40 vs 2%), and more comorbidity burden (7.4 vs 4.3 Charlson comorbidity score). High-risk episodes had more hospital admissions (0.7 vs 0.2) and intensive care unit use (17 vs 5%), longer length of stay (5.9 vs 4.9 days), and higher rates of surgery (7 vs 1%) and mortality (17 vs 2%). Among OCM quality metrics, high-risk episodes had higher inpatient admissions (42 vs 15%) and emergency department visits (37 vs 20%) relative to low-risk episodes. Average spending per high-risk BC episode was ̃$38,000 (vs $9,204 for low-risk), with ̃$11,000 spent on systemic therapies and ̃$7,000 on inpatient services. Conclusions: High-risk OCM episodes of BC, which included 40% metastatic BC, had higher HRU and costs, and lower quality performance, than low-risk episodes. Novel therapies offer a significant opportunity to optimize BC management and improve quality of care, particularly for high-risk episodes. Further, as < 3% of OCM episodes were attributed to BC, and only one-third of BC episodes were classified as high-risk, controlling expenditure on novel therapies in BC episodes is unlikely to impact overall performance for practices participating in OCM.
Real-world utilization and costs with biosimilar and reference filgrastim in patients with breast cancer receiving myelosuppressive chemotherapy in a community oncology setting from 2015 to 2017.
Authors: Rifkin Robert M. , Herms Lisa , Wentworth Chuck , Vasudevan Anupama , Campbell Kimberley , Li Edward C.
Published: September 2021

57

Background: Biosimilars have potential to reduce healthcare costs and increase access in the United States, but lack of uptake has contributed to lost savings. Filgrastim-sndz was the first FDA-approved biosimilar, and much can be learned by evaluating its uptake. In February 2016, the US Oncology Network converted to filgrastim-sndz as its short-acting granulocyte colony-stimulating factor (GCSF) of choice for prevention of febrile neutropenia (FN) following myelosuppressive chemotherapy (MCT). To understand utilization and cost patterns, this study analyzes real-world data of GCSFs within a community oncology network during the initial period of conversion to the first biosimilar available in the US. Methods: This descriptive retrospective observational study used electronic health record data for female breast cancer (BC) patients receiving GCSF and MCT at high risk of FN. Patient cohorts were defined by first receipt of either filgrastim or filgrastim-sndz during the 410 days before and after biosimilar conversion. Healthcare resource utilization (HCRU) and costs for GCSF and complete blood counts (CBC) were collected at GCSF initiation through the earliest of 30 days following end of MCT, loss to follow up, death, or data cutoff. Results: 146 patients were identified: 81 (55.5%) filgrastim and 65 (44.5%) filgrastim-sndz. No directional differences existed in baseline characteristics between the cohorts. Higher proportions of filgrastim-sndz patients received dose-dense MCT (33.8% vs 22.2%). Time trends show an initial spike in HCRU and cost for filgrastim-sndz patients after formulary conversion, which subsequently decreased and converged to that of the filgrastim cohort after 12 months. When aggregated, the overall median total administration counts, per patient per month (PPPM) and dosage, were marginally higher for filgrastim-sndz (5 vs 3; 2.9 vs 1.4; 1920 vs 1440 mcg, respectively). Median PPPM costs were higher for filgrastim-sndz ($803 vs $545). Median CBC utilization and costs were higher for filgrastim-sndz (2.8 vs 2.5; $28 vs $23, respectively). Conclusions: This study provides insight into real-world HCRU and cost patterns after formulary conversion to a biosimilar for BC patients receiving MCT and GCSF. As a descriptive study, causal inferences cannot be made and an underlying effect from index chemotherapy cannot be excluded. Convergence of HCRU and costs after 12 months suggests that overall results may be driven by behavior at initial formulary switch. Since filgrastim-sndz was the first US biosimilar approved, the uptake may be indicative of an experience with biosimilar acceptance in general. Future real-world studies of biosimilars must consider inconsistent utilization and practice trends during the time frame directly following formulary conversion.
Safety and feasibility of a nurse-led ambulatory abdominal paracentesis service.
Authors: Lee Kim Hua
Published: September 2021

63

Background: Ascites is a common complication of cancer. Symptomatic ascites contributes to cancer-related morbidity and is distressing for patients (pts). Therapeutic abdominal paracentesis (TAP) provides symptom relief but requires specialized procedural knowledge and is usually performed in the inpatient setting with several days of hospitalization. Additionally, high hospital bed occupancy during the COVID-19 pandemic prevented timely admission for TAP. An Advanced Practice Nurse (APN)-led ambulatory TAP service was introduced at our center, with the aim of improving access to TAP and reducing hospital bed occupancy. Methods: A multidisciplinary team developed workflows and safety guidelines for TAP to enable right-siting of pts in a cancer day care unit. Pts were scheduled for radiologically guided insertion of abdominal drains in the morning before 10am to allow adequate time for drainage. Pre-procedure clinical examination and safety checks were performed by APNs in the day unit. Following the procedure, abdominal fluid was drained with concurrent administration of 20% IV albumin. Drains were removed by the APN and pts were examined before discharge on the same day. Data for all cancer pts requiring TAP in the day unit and hospital from 1 Jan to 30 Nov 2020 were extracted from the electronic medical record system. The primary outcome was length-of-stay (LOS). The primary safety outcome was adverse events in the day unit. Continuous data were compared using the t-test. Data analysis was done in SPSS version 22. Results: The number of TAPs performed in the day unit and general ward requiring hospitalization were 102 and 133, respectively. There was a significant reduction in average LOS with TAPs performed in the day unit vs. hospitalization (1.48 vs. 5.82 days, p<0.001) (Table). The mean difference was 4.34 (95% confidence interval 3.33 - 5.34) days saved per pt, or a saving of 443 inpatient bed days. The TAP day unit service encountered 10 adverse events (AEs) requiring admission to the ward for continued drainage. AEs were borderline baseline blood pressure, pt frailty and inability to care for an indwelling catheter. There were no infective or bleeding complications. The majority of TAPs (86.8%) were performed in one day, with the remainder over 2-days with the abdominal drain left in-situ and reattendance at the day unit the next day for further drainage. Differences in average length-of-stay with TAP in the hospital vs. day unit. Conclusions: An APN-led ambulatory abdominal paracentesis service is a safe alternative to inpatient paracentesis. Optimal utilization of a day unit enabled reduced LOS for pts with advanced cancer. This reduction in LOS was critical during a pandemic where bed demand was high. This was possible from advanced scheduling and control over the day unit capacity.[Table: see text]
The cost of neuroendocrine tumor patient healthcare: Comparison between advanced economies and emerging and developing economies.
Authors: Gellerman Elyse , Bouvier Catherine , McDonnell Mark , Rodien-Louw Christine , Van Genechten Dirk , Leyden Simone , Dureja Sugandha , Kolarova Teodora
Published: September 2021

64

Background: The Survey of Challenges in Access to Diagnostics and Treatment for NET Patients (SCAN) measured the delivery of healthcare to neuroendocrine tumor (NET) patients globally. This analysis focused on the cost of NET care, comparing results between Advanced Economies (AE) and Emerging and Developing Economies (EDE). Methods: During Sept-Nov 2019, 2359 NET patients and 436 healthcare professionals (HCPs) from 68 countries across 6 continents completed an online self-report survey, available in 14 languages, disseminated by INCA and its partner organizations. Results: Of all respondents, 88% [2076/2359] were AE NET patients/carers, and 12% [283/2359] were from EDE. HCPs were evenly spread 51% AE [221/436] vs. 49% EDE [215/436]. Almost all patients (94% (2218/2359) were on follow-ups, most commonly on conventional imaging (74%, 1745/2359) and Chromogranin A (ChA) (50%, 1179/2359) both administered with similar frequency every third month. 66% of NET patients globally (1557/2359) declared оut-of-pocket costs related to disease management, significantly higher for EDE (84%, 238/283) vs AE (64%, 1333/2076) p<0.0001 by Chi-square). One third of EDE NET patients (33%, 93/283) spent from 50% to 100% of their annual household income on disease management over the past 12 months. 41% of AE patients (41%, 851/2076) spent up to 10% of the same. State healthcare coverage was claimed by half of AE NET patients (51%, 1064/2076). A national healthcare plan that covered NETs was mentioned by only a third of EDE NET patients (30%, 85/283). According to HCPs, newer, more specialized tools were the least affordable to all NET patients. PRRT was reported as not affordable by 9% of AE HCPs (20/221) and by significantly more – 21% of EDE HCPs (45/215) p<0.0001. Gallium 68 DOTA PET was reported as not affordable by 9% of AE (20/221) and 10% of EDE HCPs (22/215). This monitoring tool was somewhat affordable to patients according to 25% of AE (54/221) and 62% of EDE HCPs (133/215) p<0.0001. According to HCPs, leading specialized services, where available, were somewhat affordable or not at all affordable to NET patients, i.e. a clinical nurse specialized in NETs – not or somewhat affordable ( HCPs AE 16%, 17/108; EDE 37%, 16/43, p<0.0001); a multidisciplinary team (HCPs AE 18%, 34/194; EDE 39%, 68/174, p<0.0001); a NET specialist (HCPs AE 21%, 42/200; EDE 36%, 46/127, p<0.0001), psychological care (HCPs AE 58%, 42/124; EDE 41%, 11/27, p<0.0001). Psychological care was reported to be available by only 13% of EDE HCPs (27/215). Conclusions: More adequate healthcare funding and better and more inclusive healthcare plans to utilize the optimal diagnostic and treatment tools available to improve outcomes and quality of life for NET patients is needed globally. Discrepancies between AE and EDE healthcare accessibility are huge.
Shared decision-making to foster same-day discharge for patients with breast cancer undergoing mastectomy with or without immediate implant-based reconstruction.
Authors: Shelby Melissa , Byrum Stephanie , Billar Julie A , Carnes Michelle , Khan Maryam , Decker Amber , Walthall Gale
Published: September 2021

65

Background: In 2020, over 324,500 cases of invasive and non-invasive breast cancer were diagnosed, of which 36% underwent mastectomies. The post-operative period for these breast cancer patients can be an especially taxing time, not just because of the physical recovery involved, but the associated financial toxicity a patient may face. Consideration of these factors, and a desire to optimize shared decision-making between providers, nursing staff and patients, prompted the breast team at Banner MD Anderson Cancer Center (BMDACC) to coordinate a system change in post-operative planning for mastectomy patients. Methods: Implementing same day discharge (SDD) as a quality improvement process change for breast cancer patients undergoing mastectomy with or without immediate implant-based reconstruction began in December 2018. A collaborative effort to reduce length of stay while maintaining quality and safety was the goal of the process change. Shared decision making was utilized as the methodology for the quality initiative. Open communication and honest expectations of the postoperative management allowed the patient to be actively involved and helped to remove any preconceived notions about the necessity of post-operative hospitalization. A chart review comprised of retrospective data from 2017-2018 and prospective data from 2019-2020 was performed on SDD and admitted (ADM) patients who underwent mastectomy with or without immediate implant-based reconstruction. The SDD group was contacted to voluntarily answer a survey on their outpatient surgical experience using the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) .Results: The utilization of shared decision-making revealed an increase in SDD with no increase in readmission or adverse events (Table). The OAS CAHPS survey was completed by78% SDD; findings revealed 95% of patients responded positively to all questions. Conclusions: For patients undergoing mastectomy, with or without immediate implant-based reconstruction, SDD is a safe and value-based initiative that has been adopted as standard of care at BMDACC. [Table: see text]
Evaluation of drug cost avoidance resulting from conduct of cancer clinical trials in a community-based oncology practice.
Authors: Sanyal Amit , Heun James M. , Glynn Brittany , Porter Ryan , Wellner Daniel
Published: September 2021

66

Background: Aim: To prospectively evaluate cost avoidance during routine conduct of cancer clinical trials in a community based integrated delivery network (IDN) consisting of a health services provider group, a health insurance plan and a hospital system. Only 2%–7% of adult cancer patients participate in clinical trials nationwide [1]. Inadequate funding and concerns about financial viability have been identified as factors that impede clinical trial accrual in the community oncology setting. ‘Cost-avoidance’, defined as dollars that would have been spent to purchase medications but were not spent because of study-related interventions [3] has been proposed as one mechanism to overcome this. Methods: Anti-cancer and hematology drugs provided by intergroup as well as pharmaceutical industry-based trial sponsors to patients enrolled in oncology clinical research were tabulated. Analysis of cost avoidance was restricted to patients covered by the IDNs health plan. Additionally, drugs provided by the trial sponsor were included in the analysis only if they represented a normal standard of care for the disease state. Cost avoidance was defined as the net ingredient cost of the drugs that would have been spent by the health plan for patient care if drugs provided by trial sponsors were not available. Results: Between January 2020 and April 2021, 25 patients covered by the IDN were recruited into clinical trials. Cost savings resulted from 7 targeted and immuno-oncology medications. Net cost avoidance in 2020 was $1,229,798 while that in 2021 till date has been $892,783. The realized cost savings has allowed recruitment of additional clinical research staff as well as expansion of clinical research to rural regional sites served by the IDN. Conclusions: Anticancer drugs provided free of charge by clinical trial sponsors render significant cost savings, ensuring viability and even expansion of oncology clinical research in community based IDNs. References: National Health Expenditure Data. 2018, U.S. Centers for Medicare & Medicaid Services: Baltimore, MD 21244. McDonagh MS, M.S., Naden E., Costs and savings of investigational drug services. American Journal of Health-Systems Pharmacy, 2000. 57: p. 40-43.[Table: see text]
Impact of a central review oncology clinical pharmacist in a community oncology practice.
Authors: Kula Julianna , Hough Shannon , Howell Josh
Published: September 2021

68

Background: The impact and role of a clinical pharmacist in a community oncology setting is not well-described in the literature. The US Oncology Network recently implemented a central clinical pharmacist review program (ClinReview) to offer oncology remote clinical pharmacist services to practices. Methods: An oncology-trained clinical pharmacist electronically reviewed recently placed or modified chemotherapy regimen orders within a community oncology practice. The ClinReview pharmacist identified opportunities to modify ordered therapy based on clinical components, waste reduction, or financial stewardship. Recommendations were discussed with the treating oncologist at the practice or modified if permitted by approved practice policy. The pharmacist was appointed at 0.5 full-time equivalents (FTE). Financial and workload metrics were tracked to monitor the impact of the pharmacist work. Results: In 10 weeks, 388 reviews were documented and 191 (49.2%) required a modification by the pharmacist. Recommended modifications included dose rounding (n=90, 47%), a clinical change (n=72, 38%), or product substitution (n=29, 15%). The most common clinical changes included modifications to supportive care (n=32, 44%), recommendations for additional monitoring (n=19, 26%), or modifications to anti-cancer medication dose or frequency (n=18, 25%). The financial impact of the pharmacist resulted in margin improvements totaling $106,043 and a $462,305 reduction in the total cost of care in medication expenses (Table). The expense of the pharmacist during this period was $18,095. The return on investment for the pharmacist compared to margin improvement was 590%. Conclusions: An oncology clinical pharmacist is a cost-effective and valuable member of the care team in community oncology practice. The pharmacist identified opportunities to improve medication safety, regimen optimization, and demonstrated significant financial impact for the practice, payers, and patients.[Table: see text]
Factors associated with target price status within the oncology care model population.
Authors: Molaei Matthew , Walsh Karen , Keith Scott W. , Csik Valerie Pracilio , Leader Amy , Maio Vittorio
Published: September 2021

72

Background: The Oncology Care Model (OCM) is an alternative payment model put forth by the Centers for Medicare and Medicaid Services (CMS), which aims to improve quality of care for cancer beneficiaries, while reducing cost. One of the strategies implemented by CMS to achieve this goal was the development of an episode target price (TP), which uses historical data and episode specific adjusters to calculate a total cost of care goal for each episode. The goal of this analysis was to better understand how CMS risk adjustments could account for episode characteristics, as well as how these characteristics affect likelihood of meeting target price. Methods: OCM performance claims data were abstracted retrospectively from performance periods (PP) 1-6 (episodes initiated from 7/1/2016 – 12/31/2019), in which each episode captured 6 months of care. EHR data was linked to identify cancer staging for OCM Beneficiaries. Any OCM beneficiary with at least one episode in PP 1-6 was included. To assess odds of meeting TP, a logistic regression model with a generalized estimating equation was used to account for patients who contributed multiple episodes. Specific factors evaluated for their association with meeting TP included patient’s age and sex, cancer stage, cancer type, cancer related surgery, clinical trial participation, hospice status, inpatient admissions, observational stays, Medicare part B drug use and radiation therapy. Results: 4,612 episodes were included in analysis, which translated to 2,459 patients, who had an average age of 72 years old and were majority female (50.5%). 2,790 (60.5%) of the episodes met the TP set by OCM. When controlling for covariates, radiation treatment (OR = 1.75, 95%CI: 1.39-2.23), stage 2 compared to stage 4 cancers (OR = 1.86, 95%CI: 1.23-2.80), colorectal cancers (OR = 1.75, 95%CI: 1.11-2.77) and melanomas (OR = 4.35, 95%CI: 2.18-8.67) were significantly associated with increased odds of meeting TP. Novel therapies (OR = 0.19, 95%CI: 0.14-0.26), inpatient admissions (OR = 0.27, 95%CI: 0.22-0.33), observational stays (OR = 0.66, 95%CI: 0.51-0.87) and part B drug use (OR = 0.75, 95%CI: 0.60-0.93) were associated with significantly reduced odds of meeting TP. Conclusions: Our analysis suggests that radiation treatment, as well as selected cancer stage and types may contribute to increased likelihood of meeting TP, which may point to potential areas of cost savings. Conversely, specific resource utilizations such as novel therapy use, inpatient admissions, observational stays, and Medicare part B drug use may decrease the odds of meeting TP, despite being adjusted for in the OCM model. While CMS has recognized that late stage cancers require a more sensitive TP with the metastatic adjustment, other adjustments should also be considered to adequately account for episode characteristics. External validation at other OCM-participating practices is needed to corroborate these results.
Female participation in U.S. oncology clinical trials registered on ClinicalTrials.gov from 2008 to 2020.
Authors: Perera Nirosha D. , Bellomo Tiffany R. , Litt Henry K. , Fattahi Sayeh , Bell Alexander , Stavins MaKenna A. , Saleki Massoud , Ionescu Ruxandra , Shyu Margaret , Wang Max M. , Tao Jacqueline , Sarsour Nadeen , Ji Sunjong , O'Keefe Ryan M , Pun Matthew , Takasugi Jordan M. , Steinberg Jecca R. , King Roderick , Mahipal Amit , Turner Brandon E.
Published: September 2021

85

Background: Females are thought to be underrepresented in clinical trials, which may lead to care disparities. We characterized female enrollment trends in U.S. oncology trials registered on ClinicalTrials.gov and identified features associated with accurate representation. Methods: We employed a cross-sectional study design with descriptive, logistic regression, and cox regression analyses. We downloaded 270,172 studies registered on the Aggregate Analysis of the ClinicalTrials.gov database from October 1, 2008 to March 9, 2020, excluding non-interventional and reproductive organ specific trials. We then applied cancer/oncology specific Medical Subject Heading terms and manually reviewed the remaining 27,521 trials for true oncology content. Prevalence-corrected estimates for female participation were calculated as the percentage of females among trial participants divided by the percentage of females in the disease population per U.S. Surveillance, Epidemiology, and End Results Program (SEER) data (participation to prevalence ratio [PPR]), with a range between 0.8 and 1.2 reflecting accurate female representation in the trial. Results: Of 26,894 trials meeting eligibility criteria, 9,059 trials were completed in the U.S., 2,499 trials reported completed study status, and only 1,256 trials reported sex. Among 1,256 oncology trials and 229,056 participants, overall female representation was 46.9% (95% CI, 45.4-48.4%). 43% of trials were industry funded, 29% academic, and 28% U.S. government. Females were underrepresented compared to their disease burden in anal canal (PPR 0.21), thyroid (PPR 0.57), stomach (PPR 0.68), kidney (PPR 0.77), and bone (PPR 0.79) cancer trials. They were accurately represented in head and neck (PPR 0.80), lung (PPR 0.84), bladder (PPR 0.85), skin (PPR 0.88), pancreas (PPR 0.88), colon (PPR 0.90), hematologic (PPR 0.91), liver (PPR 1.01), CNS (PPR 1.03), soft tissue (PPR 1.05), and esophagus (PPR 1.05) cancer trials. Accurate representation was significantly associated with industry funding and pancreas cancer trial focus, but not associated with trial type (medical, surgical, radiation, other invasive, other) (Table). Conclusions: Females are underrepresented compared to their disease burden in many solid tumor clinical trials. Stakeholders can look to industry funded and pancreas cancer trials as models of improvement, but must increase female representation in clinical trials to improve cancer care. [Table: see text]
Financial toxicity, symptom burden, illness perceptions, and communication confidence in cancer clinical trial participants.
Authors: Perni Subha , Azoba Chukwuma , Gorton Emily , Park Elyse R. , Chabner Bruce Allan , Moy Beverly , Nipp Ryan David
Published: September 2021

86

Background: Cancer clinical trial (CCT) participants are at risk for experiencing adverse effects from financial toxicity, yet these remain understudied. We sought to describe associations among CCT participant-reported financial toxicity (financial burden [FB] and trial cost concerns), symptoms, illness perceptions, communication confidence, hospitalizations, and survival. Methods: From 7/2015-7/2017, we prospectively enrolled CCT participants who expressed interest in financial assistance (n = 100) and a patient group matched by age, sex, cancer type, specific trial, and trial phase (n = 98). We assessed FB (burdened by costs of cancer care), trial cost concerns (worried about affording medical costs of a CCT), physical (Edmonton Symptom Assessment Scale [ESAS]) and psychological (Patient Health Questionnaire-4 [PHQ-4]) symptoms, illness perceptions (Brief Illness Perception Questionnaire [BIPQ]), and communication confidence (Perceived Efficacy in Patient-Physician Interactions [PEPPI]). We used regression models to explore sociodemographic associations with FB and trial cost concerns, as well as their associations with symptom burden, illness perceptions, and communication confidence, adjusting for age, sex, race, performance status, marital status, and metastatic status. We also used Kaplan-Meier and regression methods to evaluate their associations with 6-month hospitalizations and survival. Results: Of 198 patients enrolled, 112 (56.6%) reported FB and 82 (41.4%) had trial cost concerns. Patients with FB were younger (OR 0.96, 95% CI 0.94-0.98) with lower incomes (< $100,000, OR 4.61, 95% CI 2.35-9.01). Patients with trial cost concerns had lower incomes (< $100,000, OR 2.78, 95% CI 1.45-5.29). On adjusted analyses, patients with FB had higher ESAS (OR 1.03, 95% CI 1.02-1.05), PHQ-4 depression (OR 1.54, 95% CI 1.22-1.94), and PHQ-4 anxiety (OR 1.30, 95% CI 1.08-1.55) scores, as well as more negative illness perceptions (OR 1.04, 95% CI 1.01-1.07), but no significant difference in communication confidence (OR 0.98, 95% CI 0.93-1.05). Patients reporting trial cost concerns had higher ESAS (OR 1.03, 95% CI 1.01-1.05), PHQ-4 depression (OR 1.35, 95% CI 1.10-1.65), and PHQ-4 anxiety (OR 1.27, 95% CI 1.07-1.51) scores, as well as more negative illness perceptions (OR 1.06, 95% CI 1.03-1.10), and lower communication confidence (OR 0.93, 95% CI 0.87-0.99). Financial toxicity was not significantly associated with hospitalizations or survival. Conclusions: In this study of CCT participants, younger patients with lower incomes were most vulnerable to financial toxicity. Financial toxicity was associated with greater symptoms, more negative illness perceptions, and lower communication confidence, underscoring the importance of addressing these issues when seeking to alleviate the adverse effects of financial toxicity in CCT participants.
The impact of race, education, and employment status on cost-coping strategies and patient reported benefit from interventions to mitigate financial toxicity.
Authors: Braxton Kenya , Thom Bridgette , Brown Carol L. , Gany Francesca , Chino Fumiko , Aviki Emeline Mariam
Published: September 2021

91

Background: As patient financial toxicity increases with the cost of cancer healthcare, patient outcomes and quality of life may be impaired. We sought to evaluate sociodemographic factors associated with use of cost-coping strategies, as well as strategies to mitigate financial toxicity. Methods: We conducted a survey of consecutive patients in an urban outpatient gynecologic cancer clinic waiting room over 2 weeks in August 2019. The survey included patient demographics, disease characteristics, the Comprehensive Score for Financial Toxicity (COST; scored 0-44, lower scores indicate worse outcomes), assessment of cost-coping strategies, and patient-reported anticipated benefit from possible interventions. Patients were categorized by race/ethnicity (non-Hispanic white, Hispanic white, black, Asian, other) and employment and education status. Kruskal-Wallis and Fisher’s exact tests were used to assess differences between groups. Results: Of 101 patients, 75 completed the survey. Most patients were non-Hispanic white (60%), retired (45%), and had at minimum a bachelor’s degree (65%). The median COST score was 32 (range 6-44). For cost-coping strategies, among renters (n=48), black and other race patients compared to white patients more often indicated skipping a rent payment (25% and 50% vs 0%; p<.01). Employed patients compared to retired patients more often indicated reducing leisure spending (58% vs 27%; p=.02). Patients with less than a bachelor’s degree compared to those with a bachelor’s degree or higher more often indicated borrowing money to pay for medical bills (24% vs 6%; p=.04). For proposed interventions to lessen financial toxicity, non-Hispanic white and Asian patients compared to black patients more often indicated they wanted to know the cost of their healthcare upfront (38% and 33% vs 0%; p =.26). Employed patients compared to unemployed and retired patients more often indicated that minimizing copays would be beneficial (36% vs 13% and 12%, p=.05). Patients with less than a bachelor’s degree compared to those with a bachelor’s degree or higher more often indicated that transportation assistance would be helpful (76% vs 24%; p<.01). Conclusions: As the needs of different sociodemographic groups vary, so do their cost-coping strategies and preferred interventions to ameliorate financial toxicity. Varying patient needs should be considered when developing interventions to mitigate financial toxicity. Next steps should assess the benefit of targeted interventions on coping strategies in specific sociodemographic groups.
Evaluating the user-perceived benefit of a virtual patient education and support community: LVNG With Lung Cancer.
Authors: Martin Mona L. , Bucklen Kristin , Hall Lise J. , Sandy Beth , Wonser Dann , de Renne Genevieve
Published: September 2021

92

Background: The accessibility and quality of network support for people living with lung cancer (PLW) and their support partners (SP) can vary. Virtual platforms provide a unique opportunity for PLW/SP peer support and disease education; the challenge is to measure impact. Methods: Our aim was to determine user-perceived benefit of the Facebook-based virtual community LVNG With Lung Cancer ( https://www.facebook.com/LVNGWithLungCancerUS ). Qualitative interviews were conducted with community members aged ≥18 yrs and living with lung cancer or actively supporting someone who had lung cancer. Also, inbound community comments (Dec 2015–Oct 2016) were retrospectively analyzed and grouped by similarity of content. Results: 18 PLW and 2 SP were interviewed (N = 20, saturation of concept met within the first 10). Mean yrs since diagnosis was 2.75 (range 0.08–17). Of the total expressions of benefit (n = 513) made during the interviews, 32% focused on increased health knowledge, with most participants calling out cancer information, good health behaviors, and coping strategies as key community benefits. Social impacts of the community accounted for 28% of benefit expressions; having a forum to share experiences and having a supportive environment were most frequently cited. An additional 18% of benefit expressions revealed that the community gives members feelings of empowerment, including feeling less alone (55% of respondents) and feeling inspired to help others (40% of respondents). Benefits received from community membership led to behavioral change in many respondents: 55% asked their doctor more questions, 50% shared helpful experiences with other members, and 35% took a more active role in their healthcare. In a notable example, an SP member said the community provided her with the knowledge she needed to address her symptoms and fears with her doctor, who was hesitant to biopsy because she did not meet typical risk criteria. Her self-advocacy was successful and ultimately led to an early lung cancer diagnosis. Results from the retrospective analysis of actual postings (n = 24,336; all unique users during evaluation period: n = 12,187) reflected the themes patients offered during interviews as important reasons to participate: 63% of postings were asking for or sharing cancer information, 98% provided emotional support and/or understanding, and 84% were inspirational/optimistic. Conclusions: This dual approach of assessing real-world impact of a virtual Facebook community provided insight into the benefit that members derive and highlighted the integral role of support groups in patient-centric care. Importantly, once members’ emotional and educational needs were met, they were empowered and/or inspired to take positive actions leading to better health behaviors and increased quality of life – an outcome that may have wider applicability for diseases beyond lung cancer.
Overall survival benefits of advances in NSCLC systemic treatments: Younger versus older adults.
Authors: Leung Bonnie , Shokoohi Aria , Al-Hashami Zamzam Salam , Moore Sara , Pender Alexandra , Wong Selina K. , Wang Ying , Wu Jonn , Ho Cheryl
Published: September 2021

93

Background: Historically, there has been limited systemic therapy options for older adults with cancer attributed to underlying frailty, co-morbidities, poor functional status, and limited social supports. In the past decade, treatment for advanced NSCLC has changed with increasing availability of novel therapeutics associated with improved tolerability and efficacy, such as targeted therapy and immunotherapy. The study goal is to compare the difference in overall survival (OS) between younger adults and older adults with the introduction of novel therapeutic options. Methods: All patients with stage IV NSCLC referred to BC Cancer in 2009, 2011, 2015 and 2017 were included in the study. One-year time points were chosen based on molecular testing implementation and provincial formulary listing: baseline (2009), EGFR testing (2011), ALK testing (2015) and immunotherapy listing (2017). Age was categorized as younger (< 70 years) and older (≥70 years) adults. Baseline demographics, simplified comorbidity score (SCS ≥9 associated with poor prognosis), disease characteristics, and systemic therapy details (agent, duration, line of therapy) were collected retrospectively. Univariate analysis using X2 and Fisher’s exact tests were used to compare age groups. OS was calculated using the Kaplan-Meier method and compared using the log-rank test. Results: 3325 patients with stage IV NSCLC were identified. Baseline characteristics for patients < 70 y; female 51%, non-squamous 62%, ECOG ≥2 50%, SCS ≥9 29% vs patients ≥70 y; female 49%, non-squamous 57%, ECOG ≥2 61%, SCS ≥9 58%. In the four time cohorts 2009/2011/2015/2017, systemic treatment was delivered to < 70 y 44/53/51/52 % vs ≥70 y 23/25/28/30 %. Median OS with BSC for < 70 y 3.1/2.8/2.8/2.5 m vs ≥70 y 3.8/3.3/3.4/3.1 m (p = 0.10). Median OS with systemic treatment for < 70 y 9.0/10.9/13.9/15.5 m (p < 0.001) vs ≥70 y 11.4/11.7/13.9/14.9 m (p < 0.001). Median OS by type of treatment BSC/chemotherapy only/targeted therapy/immunotherapy; < 70 y 2.8/8.9/21.4/20.2 m vs ≥70 y 3.1/10.1/21.5/20.1 m (p < 0.001). Conclusions: In this real-world retrospective review of patients with advanced NSCLC, there was an increased uptake of systemic therapy for both age groups with the introduction of novel therapeutics. Although there was a smaller proportion of older adults who received systemic therapy, those who received treatment had comparable OS to their young counterpart. The benefit of systemic therapy in both age groups was seen across the different types of treatments. This suggests with careful assessment and selection of appropriate candidates, older adults with advanced NSCLC should receive equitable access to systemic therapy.
Nature's Wild
Authors: Gosine Andil
Published: September 2021

In Nature's Wild, Andil Gosine engages with questions of humanism, queer theory, and animality to examine and revise understandings of queer desire in the Caribbean. Surveying colonial law, visual art practices, and contemporary activism, Gosine shows how the very concept of homosexuality in the Caribbean (and in the Americas more broadly) has been overdetermined by a colonially influenced human/animal divide. Gosine refutes this presupposed binary and embraces animality through a series of case studies: a homoerotic game called puhngah, the institution of gender-based dress codes in Guyana, and efforts toward the decriminalization of sodomy in Trinidad and Tobago—including the work of famed activist Colin Robinson, paintings of human animality by Guadeloupean artist Kelly Sinnapah Mary, and Gosine's own artistic practice. In so doing, he troubles the ways in which individual and collective anxieties about “wild natures” have shaped the existence of Caribbean people while calling for a reassessment of what political liberation might look like.

>Duke University Press Scholars of Color First Book Award recipient
SureTypeSCR: R package for rapid quality control and genotyping of SNP arrays from single cells
Authors: Vogel Ivan , Cai Lishan , Jerman-Plesec Lea , Hoffmann Eva R.
Published: September 2021

Genotyping of single cells using single nucleotide polymorphism arrays is a cost-effective technology that provides good coverage and precision, but requires whole genome amplification (WGA) due to the low amount of genetic material. Since WGA introduces noise, we recently developed SureTypeSC, an algorithm to minimize genotyping errors. Here, we present SureTypeSCR, an R package that integrates a state-of-the-art algorithm (SureTypeSC) for noise reduction in single cell genotyping and unites all common parts of genotyping workflow in a single tool. SureTypeSCR is built on top of the tidyverse ecosystem, which facilitates common operations over the data and allows users to create and experiment with the genotyping pipeline. Furthermore, the workflow of SureTypeSCR can also be used for standard genotyping of bulk DNA for batch processing in a single pipeline. SureTypeSCR is avaliable from: https://github.com/Meiomap/SureTypeSCR
Hematologic and coagulopathy parameter as a survival predictor among moderate to severe COVID-19 patients in non- ICU ward: a single-center study at the main referral hospital in Surabaya, East Java, Indonesia
Authors: Bintoro Siprianus Ugroseno Yudho , Dwijayanti Ni Made Intan , Pramudya Dana , Amrita Putu Niken , Romadhon Pradana Zaky , Asmarawati Tri Pudy , Bachtiar Arief , Hadi Usman
Published: September 2021

Background : This research aimed to examine and analyze risk factors for death, hematologic parameters and coagulation in COVID-19 patients at RSUD Dr. Soetomo Surabaya, one of the referral centers for probable COVID-19 patient cases in East Java.

Method : This was a retrospective analytical study by taking secondary data on patients with probable COVID-19 cases who were treated in hospital isolation rooms from May to September, 2020.

Result : Of 538 probable COVID-19 patients, 217  tested positive, with an average age of 52.11±13.12 years, and there were 38 death cases. Hematologic parameters, such as white blood cell, neutrophil and lymphocyte counts, were significantly different in the deceased group. On the other hand, coagulation parameters, consisting of D-dimer, CRP, PT, and aPTT showed significantly similar value in the deceased group. Univatiate analysis concluded that chronic kidney disease, diabetes mellitus, coronary heart disease, WBC, NLR, and PPT counts could predict the mortality, while multivariate analysis revealed that coronary heart disease was the only significant independent predictor of mortality.

Conclusion : This research shows that hematologic and coagulation parameters were increased in the majority of COVID-19 patients and the deceased group. While the number of neutrophils and WBC increases, the number of lymphocytes decreases significantly with increasing disease severity. Coronary heart disease is an independent predictor of mortality.
Dermatoglyphics and abdominal resistance in female children and adolescents: a cross-sectional study
Authors: Souza Renan , Alberti Adriano , Gastélum Cuadras Gabriel , de Souza Vale Rodrigo Gomes , Marcio Zanoni Eliton , Benetti Zavorski Eloel , Aparecida De Jesus Josiane , Hur Soares Ben , Pertille Fabiane , Fin Gracielle , Becker da Silva Bruna , R. Grigollo Leoberto , D. Schlindwein Aline , Freiberger Viviane , Ventura Leticia , Quadros Luana , Alfonso González Rivas Ramón , Núñez Enríquez Oscar , Islas Guerra Samuel Alfredo , Valenzuela Jurado Felipe , Iván Chávez Erives Arturo , Martínez Treviz Arturo , Arnoldo García Fernández David , Marques Leão Graziela , Comim Clarissa Martinelli , Nodari Junior Rudy José
Published: September 2021

Background: Dermatoglyphics is considered, in the scientific milieu, to be an epigenetic marker. The objective of this study was to analyze the presence of dermatoglyphic marks characteristic of neuromotor capacity and abdominal resistance in children and adolescents.

Methods: This is a cross-sectional study. The sample consisted of 1,002 individuals, female children and adolescents between the ages of 10 and 16, from public and private schools in the city of Joaçaba, Santa Catarina, Brazil. The protocol selected for analyzing the fingerprints was dermatoglyphics, proposed by Cummins and Midlo using a Dermatoglyphic Reader. The Brazilian Sports Project Manual - PROESP 2015 was used to collect data on muscle strength motor tests.

Results: The results showed the presence of a dermatoglyphic mark characteristic of abdominal motor capacity and muscle strength in females. A higher frequency of arches was identified in MET4 and whorls in MET5 and MDT4 in the Risk Zone group. In the Healthy Zone group, ulnar loop was found to be more frequent in MET4, MET5, and MDT4 fingers.

Conclusions: The results demonstrated a predictive marker for abdominal motor capacity and strength in females through dermatoglyphics.
Extending and paralleling Stechkin's category theorem
Authors: Zamfirescu Tudor
Published: September 2021

We strengthen one of Stechkin's theorems. We also obtain results in the same spirit regarding the farthest
point mapping. We work in length spaces, sometimes without bifurcating geodesics, sometimes with geodesic extendability.
Nonlinear Volterra delay evolution inclusions subjected to nonlocal initial conditions
Authors: Yu Yang-Yang , Wang Rong-Nian , Vrabie Ioan I.
Published: September 2021

This paper deals with a nonlinear Volterra delay evolution inclusion subjected to a nonlocal implicit initial condition. The evolution inclusion involves an $m$-dissipative operator (possibly multivalued and/or nonlinear) and a noncompact interval. We first consider the evolution inclusion subjected to a local initial condition and prove an existence result for bounded $C^0$-solutions. Then, using a fixed point theorem for upper semicontinuous multifunctions with contractible values, we obtain a global solvability result for the original problem. Finally, we present an example to illustrate the abstract result.
Nonlinear perturbations of a periodic fractional Laplacian with supercritical growth
Authors: Figueiredo Giovany M. , Moreira Sandra I. , Ruviaro Ricardo
Published: September 2021

Our main goal is to explore the existence of positive solutions for a class of nonlinear fractional Schrödinger equation involving supercritical growth given by $$ (- \Delta)^{\alpha} u + V(x)u=p(u),\quad x\in \mathbb{R^N},\ N \geq 1. $$ We analyze two types of problems, with $V$ being periodic and asymptotically periodic; for this we use a variational method, a truncation argument and a concentration compactness principle.
Linearization of topologically Anosov homeomorphisms of non compact surfaces of genus zero and finite type
Authors: Cousillas Gonzalo , Groisman Jorge , Xavier Juliana
Published: September 2021

We study the dynamics of {\it topologically Anosov} homeomorphisms of non-compact surfaces. In the case of surfaces of genus zero and finite type, we classify them. We prove that if $f\colon S \to S$, is a Topologically Anosov homeomorphism where $S$ is a non-compact surface of genus zero and finite type, then $S= \mathbb{R}^2$ and $f$ is conjugate to a homothety or reverse homothety (depending on wether $f$ preserves or reverses orientation). A weaker version of this result was conjectured in \cite{cgx}.
Componentwise localization of critical points for functionals defined on product spaces
Authors: Precup Radu
Published: September 2021

A new notion of linking is introduced to treat minima as minimax points in a unitary way. Critical points are located in conical annuli making possible to obtain multiplicity. For functionals defined on a Cartesian product, the localization of critical points is given on components and the variational properties of the components can differ, part of them being of minimum type, others of mountain pass type.
Resonance, Dissonance, Resistance and 1 Timothy 2.8-15: The Eschatological Obsolescence and “Rewriting” of a Proscriptive Text
Authors: Towner Philip H.
Published: September 2021

This study asks whether translation might be a valid mode of (literary) criticism. It approaches a hortatory biblical text (1 Timothy 2.8-14 [3.1a]), somewhat notoriously and rigidly applied in some quarters of the church as containing timeless ethical instruction concerning women in the church, from the standpoint of its intertextual network, listening for resonance and dissonance as the relevant intertexts and precursor texts are explored. It is ultimately diagnosed as a text that is eschatologically obsolescent, and translated/rewritten, on the basis of its intertextual composition, to reflect the openness inscribed by the authorial Other.