bluuebunny/crossref_metadata_2025 huggingface dataset:
Health equity regional symposia: Convening local stakeholders to address health disparities in the US.
Authors: Moadel Alyson B. , Price-Haywood Eboni , Bell Kimberly , Halmos Balazs , Dinkins Yvette , Simpson Audrea Juny , mckenzie meghan , Alvarez Daniel , Lebantino Kristopher , Theodore Pierre , Sandoval Veronica
Published: May 2024

e13695

Background: Health inequities among underserved populations in the U.S. are complex and derive from unequal access to quality healthcare. Addressing these disparities requires a coordinated effort among multiple stakeholders. Genentech’s Health Equity Regional Symposia Program was created to reduce healthcare disparities by convening stakeholders representing community, patient, academic, policy, and health care interests. Methods: Specific criteria were employed to identify hosting locations, including regions with documented health disparities; areas serving a significant proportion of patients of color; sites with a vested interest in engaging historically underserved and/or underrepresented communities in clinical studies; organizations that have built a trusted relationship with the community. Since 2022, 79 programs have been funded and several organizations hosted multiple events. To date, 58% of programs focused on oncology and applied a range of formats including patient panels, research posters, and interactive presentations. Symposium topics were driven by local community needs and included: cancer prevention, screening, treatment barriers, and research; social drivers of health; and mental health. For each symposium, the cultural and preferred language of attendees was considered, and active discussions were held and centered on generating actionable solutions. Results: The symposia have reached more than 11,000 attendees including an estimated 63% healthcare professionals and 37% community members/patient advocates. A diverse mix of health-focused community organizations participated representing 23 states. Building community trust was a consistent theme across the symposia. Key results reported by the hosting organizations included: in a post-event survey, attendees reported more trust in cancer research and clinical trials, and expressed increased motivation to get screened (Bronx, NY); patient educational materials were developed with input from cancer survivors on tips to stay healthy (New Orleans, LA); due to the trusted relationship with patients, primary care physicians act as a crucial gatekeeper in diagnosis and care (Memphis, TN); increased community commitments to conduct cancer screenings (Cleveland, OH). Conclusions: Through our symposia, we successfully convened influential stakeholders focused on generating tangible solutions to improve the health of their communities. This approach can serve as a model to advance patient outcomes.
Factors associated with delays in care of suspicious lung nodules at an academic medical center.
Authors: Rama Nihar , Nordgren Rachel , Husain Aliya N. , Juloori Aditya , Bestvina Christine M. , Thawani Rajat , Garassino Marina Chiara , Murgu Septimiu , Wagh Ajay , Hogarth Douglas Kyle , Barth Carrie , Bryan Darren , Ferguson Mark K. , Donington Jessica , Madariaga Maria Lucia
Published: May 2024

e13705

Background: Shorter time to lung cancer diagnosis and treatment are associated with improved outcomes. Here, we assessed factors contributing to delays in each phase of care to identify targets for improving the timeliness of suspicious lung nodule care in a diverse patient population. Methods: We conducted a retrospective study of patients evaluated for suspicious lung nodules at an academic medical center from 2020 to 2022. Patients with presumed or proven stage I/II lung cancer were included. Patients with stage III/IV and non-primary lung cancers were excluded. Multivariable Cox regressions were performed. Results: Of 157 patients, mean age was 70±8.6 years, 59% were female, and 53% were Black. Most lung nodules were biopsied bronchoscopically (61%) or surgically (26%). Most (83%) nodules were stage I/II non-small cell lung cancer, 10.2% were benign and 4.4% were other. Treatment was surgery in 48% and stereotactic body radiotherapy (SBRT) in 41%. Median intervals were 4 (IQR 0-18) days from nodule identification to referral, 7 (IQR 3-14) days from referral to consultation, 20 (IQR 12-34) days from consultation to biopsy, 4 (IQR 2-6) days from biopsy to diagnosis, and 28 (IQR 8-43) days from diagnosis to treatment initiation. Multivariable Cox regression showed that longer time from referral to diagnosis (TTD) was associated with Black race, widowed status, and referral > 1 year from the start of the COVID-19 pandemic. Longer time from referral to treatment (TTT) was associated with female gender, widowed status, 4th Area Deprivation Index (ADI) quartile, frailty, BMI > 18.5, ECOG performance status < 2, bronchoscopic biopsy, and initial treatment with SBRT. Longer time from consultation to biopsy was associated with female gender, widowed status, frailty, no cardiovascular disease, and living >12.5 miles from the hospital. Longer time from diagnosis to treatment was associated with Medicaid, referral > 1 year from the start of the pandemic, cardiovascular disease, and SBRT. Conclusions: The longest delays in lung nodule care are associated with time from consultation to biopsy and from diagnosis to treatment. Efforts to address disparities and modifiable factors could improve the timeliness of care for patients with suspicious lung nodules. [Table: see text]
Individual and neighborhood-level factors associated with disruptions in patients with gynecologic cancers undergoing radiation treatment.
Authors: MacArthur Emily Claire , Froehlich Allison , Wethington Stephanie L. , Rositch Anne , Santos Sydney , Lewis Dana , Ferriss James Stuart , Beavis Anna
Published: May 2024

e13713

Background: Disparities in cancer health outcomes are driven in part by social determinants of health (SDOH). Health-related social needs (HSRN) are downstream modifiable manifestations of SDOH. It is critical to identify patients with HRSN who may benefit from early intervention to improve health outcomes. Methods: We identified all patients who received radiation treatment (RT) for gynecologic cancer at an urban, academic center from January 2021-August 2023 and completed HRSN screening. HRSN screening queries patients on food, housing, transportation, and financial insecurity as well as help reading hospital materials. We extracted demographic and clinical data, self-reported HRSNs, and separately screened each chart for additional evidence of transportation insecurity. We extracted area deprivation index (ADI), a measure of neighborhood level socioeconomic disadvantage, based on home address. Any RT disruption was the primary outcome. We compared patients with and without any RT disruption using Fisher’s exact tests. Univariate Poisson regression was used to examine the magnitudes of association between individual and neighborhood level factors and RT disruption. Results: A total of 127 patients met inclusion criteria. Median age was 62 (interquartile range 25%-75%: 53-71). Most (54%, n=69) patients were White, 32% were Black (n=41), and 14% were another race (n=17). Sixteen percent (n=20) reported at least one HRSN. Six percent of patients (n=8) resided in neighborhoods in the 81st-100th percentile ADI. A total of 26% (n=33) of patients had any RT disruption, and these patients differed on individual and neighborhood factors (Table). Patients with public insurance were 2.4 times as likely to have RT disruption compared to those with private insurance (95% confidence interval [CI]: 1.4-4.2). Self-reporting at least one HRSN was associated with a 2.3 times higher risk of RT disruption (95% CI: 1.31-4.11). Chart-derived evidence of transportation insecurity was associated with a 2.6 times higher risk (95%CI: 1.5-5.6) of RT disruption. Residing in a neighborhood with an ADI above the 80%ile was associated with a 3.3 times higher risk (95% CI: 2.0-5.5) of disruption. Conclusions: A variety of measures of SDOH both at the individual and neighborhood-level were associated with RT disruptions. While we did not have the power to perform multivariate analyses, our results suggest the ADI – which can be readily obtained from a patient’s home address – could help identify those patients most at risk of disruption to care. [Table: see text]
Clinical practice guidelines for adolescent and young adult cancer: A literature review.
Authors: Atway Rayann , Ritzwoller Dawn , Moreton Elizabeth , Haines Emily Ruth , Thom Bridgette , Lux Lauren , Smitherman Andrew Brian , Stein Jacob Newton
Published: May 2024

e13727

Background: Cancers among adolescents and young adults (AYA, aged 15-39) are rising in incidence, yet formal guidelines for diagnosis, treatment, and management of AYA-specific cancers are not widely known or disseminated. Practice patterns vary widely, contributing to a lack of improvement in outcomes for this underserved population. Clinicians and health systems have reported a need for additional guidance in care delivery for AYAs. Methods: We conducted a comprehensive literature review to identify clinical practice guidelines for cancer care delivery specific to AYAs published in PubMed or MEDLINE since 2010. MeSH and other key words were applied, using a search strategy guided by a health science librarian (EM). 795 papers were identified, with 690 excluded based on title and abstract review. 105 papers underwent full text review, and 64 papers underwent complete data extraction. Using Covidence software, two team members independently reviewed articles at the data extraction phase, with disagreements resolved through discussion. Results: We identified 22 papers that met our inclusion criteria as clinical practice guidelines specific to AYA cancer care. Clinical focus included breast cancer (4), sarcoma (4), brain tumors (2), gynecologic malignancies (2), acute lymphoblastic leukemia (1), colorectal cancer (1), NUT carcinoma (1), and proton therapy (1). Six papers covered general principles of caring for AYAs, regardless of cancer diagnosis. Key themes across guidelines included the importance of fertility preservation and psychosocial support, multidisciplinary care provided at specialized centers, and consideration of long-term toxicities of treatment. Conclusions: Clinical practice guidelines exist to inform clinicians and health systems on best practices for caring for AYAs with cancer, a growing and underserved population. Further dissemination of these guidelines may assist with improving outcomes. Comprehensive summary of these and other AYA specific guidelines is forthcoming and may serve as a useful clinical reference. [Table: see text]
Racial disparities in patients with ALL according to a national dataset.
Authors: Khan Fayaz , Rahima Kenan
Published: May 2024

e13733

Background: Racial disparities in healthcare refer to differences in health outcomes, access to healthcare &quality of care among racial or ethnic groups. Aim of study is to investigate the characteristics and clinical outcomes of racial differences in patients admitted with ALL. Methods: We queried the National Inpatient Sample between 2017-2020 for adult patients of different races who were hospitalized with ALL. The primary outcome was inpatient mortality; secondary outcomes were cardiac arrest, invasive mechanical ventilation, length of stay & hospital cost. Multivariable logistic, linear & Poisson regression analyses were used to estimate clinical outcomes with p-value < 0.05 was significant. Results: Total 110999 hospitalizations with ALL. Mean age 46 years & 55.8% male. Among admitted, 59599 (53.7 %) were Caucasian, 9205 (8.3 %) were Black, 27565 (24.8%) were Asian, 4540 (4.1%) were Hispanic, and 10090 (9.1%) were others. Subgroup with Caucasian, Blacks, Asians, Hispanics, and other races had Medicare 34.9% vs 30.2% vs 13.5% vs 17.9% vs 12.5%, Medicaid 13.3% vs 29.7% vs 41.4% vs 19.2 vs 34.8%, Non-insured 2.1% vs 5.1% vs 10.6% vs 4.2% vs 7.7%; DM 19% vs 23.8% vs 24.6% vs 17.4% vs 20.7%; Protein calorie malnutrition 11 % vs 10.6% vs 10.1% vs 12.6% vs 10.2%, respectively. All-cause mortality was 3810, where subgroup with Caucasian, Black, Asian, Hispanic, and others were 2085 (3.5%) vs 410 (4.4%) vs 885 (3.2%) vs 145 (3.2%) vs 285 (2.8%). Conclusions: Among the racial categories, Caucasians comprised the largest portion followed by Asians, Blacks, Hispanics. Mortality and intubation proportion was highest among Blacks followed by Hispanics & Asians. Cardiac arrest proportion was highest among Blacks followed by Hispanics and Asians. LOS was highest among Hispanics followed by Asians & Blacks. Resource utilization was highest in Hispanics followed by Asians & Blacks. Understanding these disparities is essential for improving healthcare equity and ensuring that all patients receive appropriate & equitable care regardless of their racial/ethnic background. Interventions include improving access to healthcare, culturally competent care and addressing social determinants of health that affect racial/ethnic groups. [Table: see text]
Rectal cancer: Demographics and healthcare outcomes in a minority-rich community hospital.
Authors: Cholankeril Michelle , Sankhe Rachel , Salinas Flavio Eduardo , Polyak Andrew , Smith Keia
Published: May 2024

e13735

Background: Rectal cancer (RC) has seen a decreasing incidence and mortality due to national screening guidelines, innovative therapies and new technology. In recent years, however, we have noted shifts in its demographics pertaining to variation in stage at diagnosis and mortality rates amongst various ethnic groups. Minority populations, namely Hispanic (H) and Black (B) patients (pts), continue to see higher incidence, diagnosis at more advanced stages and poorer survival than White (W) pts. In B pts, mortality rates are higher with an increased likelihood of distant-stage RC creating a significant survival disparity. Current studies involving H and Asians(A) show similar disparities. Compared to other malignancies, RC has improved survival for pts when diagnosed in a timely fashion and therefore, we seek to identify potential patterns within the diverse population we care for. Methods: Trinitas Medical Center RWJBH is an urban, community hospital that predominantly treats a minority population. With institutional IRB approval, we completed a retrospective chart review of 59 pts diagnosed with Stage I-IV RC from 2017- 2023. Pts were treated at our cancer center. We assessed age and stage at diagnosis and demographics such as age, sex and ethnicity. Results: We reviewed 59 pts with the following ethnic distribution: 22 H, 21 W, 11 B and 5 A pts. The median age at diagnosis with RC was 57 in H, 64 in B, 71 in W 71. More males were diagnosed in all groups except A pts. B pts were found to be diagnosed with more advanced disease: 36% at Stage III, 45% at Stage IV. W pts also saw a similar trend with 33% at Stage III and 24% at Stage IV. Our H pts had comparatively fewer distant stage diagnoses: 23% at Stage III, 18% at Stage IV. Common sites of metastasis in B: liver 27%, lung 27%, locoregional lymph nodes 9%. In W pts: liver 24%, locoregional lymph nodes 24%, lung 10% and brain 5%. In H pts, 10 of 22(45%) were diagnosed without metastatic disease, though of the 10 who did, 2 had brain involvement. Mortality was highest in B pts at 55%, 33% for W, 20% for A and 18% for H pts. Conclusions: In our study, we note H pts being diagnosed at an earlier median age, at earlier stages of disease, with higher survival rates. Our B pts were diagnosed younger than W pts, at later stages of disease, with higher mortality rates. Brain involvement, which usually is rare, was seen in both H and W upon recurrence. Despite having a multi specialized cancer center, we note limitations in our access to screening resources and the availability of colorectal surgical expertise to enhance care for our underserved population. The challenge of disentangling disparities within RC will benefit from improved healthcare access and availability of multimodality resources in this disease state where cure is the ultimate goal.
Impact of racial disparities in adjuvant treatment of triple negative breast cancer (TNBC) among American Indians/Alaskan Natives (AI/AN) and non-Hispanic Whites (NHW) on overall survival (OS).
Authors: Gaba Anu G. , Cao Li , Renfrew Rebecca , Sahmoun Abe Eric , Goel Sanjay , Crosby Ross
Published: May 2024

e13736

Background: There are significant differences in patient and tumor characteristics among AI/AN and NHW breast cancers (BC) which adversely impact overall survival in AI/AN. Prior studies have also shown higher Mortality: Incidence ratio for BCs in AI/AN as compared to NHW. The aims of this study are to 1) investigate disparities in adjuvant treatment of TNBC between the two races adjusting for age, stage, and year of diagnosis; and 2) Assess differences in OS. Methods: This was a hospital based, retrospective cohort study using the National Cancer Database. AI/AN and NHW women with TNBC, greater than or equal to 18 years of age, diagnosed with BC between the years 2010 through 2019, stages I, II, and III were included. Propensity score matching in a 1:3 ratio was used for age, year, and analytical stage at diagnosis. Primary endpoint was time to first treatment and compliance with recommended treatment. Secondary endpoint was OS. Results: A total of 489 AI/AN and 1465 matched NHW women with TNBC were identified. AI/AN women traveled longer distances for cancer care (p<.01), resided in lower median income zip codes at the time of diagnosis (p<.001), had a higher Charlson-Deyo (CD) comorbidity score (p<.001), and were less likely to have private insurance (p<.001). There was no difference in the rates of chemotherapy, surgery, and radiation therapies that were recommended and received by the two races. Time to first treatment was significantly longer for AI/AN as compared to NHW women (Mean ± SD: 35 ± 27 days vs. 39 ±27 days; p=.005). Multivariable analysis revealed that longer time to first treatment was associated with only higher CD score (p=.013) and non-private insurance (p=.027), but no longer associated with race (p=.324). Compliance with recommended treatment was similar between AI/AN and NHW women (93.5% vs 92.9%, p=.096). Compliance was significantly associated with only insurance status (p < .001) with Medicare/Medicaid having the lowest compliance. OS did not differ by race (p=.299, HR=1.132; 95% CI: 0.90-1.43). Cancer stage, CD score, insurance status, and treatment compliance were associated with worse OS. Conclusions: In patients with TNBC, there was no difference in time to treatment, compliance with recommended treatment or OS among AI/AN in comparison to White women when matched for age, stage, and year of diagnosis. Medicare/Medicaid insurance was associated with prolonged time to treatment, lower compliance with recommended treatment and decreased survival when compared with other insurances. Higher comorbidities adversely impacted time to treatment and overall survival. In order to improve BC mortality, it is important to manage comorbid conditions and improve detection of cancer at earlier stages. Prospective studies comparing outcomes by race are needed to confirm these findings.
Advancing team science and health equity in clinical oncology using the All of Us Research Program dataset.
Authors: Watson Karriem S , Baskir Rubin , Smith JoAnn , Mitiku Anna , Aschebrook-Kilfoy Brisa , Tossas Katherine Y , Collins Yvonne
Published: May 2024

e13741

Background: The All of Us Research Program ( All of Us) is one of the largest, most diverse health databases developed to expedite medical breakthroughs and is a resource for cancer researchers. The size and diversity of participants along with data types within the program, coupled with the program’s cloud based data analytics platform, encourage both team science and equitable health research outcomes. All of Us is dedicated to advancing the science of health equity with a focus on populations underrepresented in biomedical research and workforce, and embedding health equity across all aspects of the program. Methods: All of Us uses a centralized protocol where participants may elect to 1) enroll, consent, and authorize EHR, 2) answer surveys, 3) provide physical measurements, 4) provide biosamples, and 5) share data from wearables. High levels of participant diversity was achieved through an Engagement Ecosystem of outreach leaders, participants, and engagement awardees. Outreach, engagement, enrollment, and retention efforts are strategically directed by a Community and Participant Engagement Framework and a Health Equity Strategic Plan. Results: As of January 2024, health data from 413,450+ participants is available, including eight survey types from 337,500+ participants, electronic health records (EHR) from 287,000+ participants, wearable data from 15,600+ participants and whole genome sequencing from 245,350+ participants. Over 75% of participants self-identify as underrepresented in biomedical research, and about 45% self-identify as racial and ethnic minority groups. Cancer data includes history at enrollment as well as incident ascertainment via EHR (N = 26,323 total cancers and 13,067 incident cancers, from 7,544 participants assigned female at birth and 5,264 participants assigned male at birth). As of February 2024, All of Us data has been used in more than 221 publications. Of these, 35% (78) discuss cancer or oncology. More than 10% of active workspaces (921 out of 8000+ as of January 2024) include “cancer” in workspace descriptions. Commonly studied cancer types include breast, prostate, lung, ovarian, and colorectal. Conclusions: All of Us has established itself as a resource for cancer researchers. This database has the potential to provide insights into the development of treatment guidelines and emerging indicators for screening and early detection guided by health equity built on participant engagement, diversity, and broad data availability. Finally, the breadth of All of Us data also offers potential insight into cancer etiology and opportunities for prevention.
Feasibility of universal breast cancer risk assessment in a diverse, publicly insured obstetrician gynecology clinic.
Authors: Enriquez Allan , Weiss Jessica M. , Chandler Isabelle , Brewer Jesse T. , Webster Emily M. , Ahsan Muhammad Danyal , Wang Ann , McDougale Auja , Sharaf Ravi N. , Frey Melissa Kristen
Published: May 2024

e13759

Background: Breast cancer is the most diagnosed cancer among women in the United States. Established breast cancer risk assessment (BCRA) tools can estimate a woman’s lifetime risk and inform the need for enhanced breast screening which can improve cancer-associated morbidity and mortality. Currently, critical disparities exist both in breast cancer prognosis and screening uptake. We aimed to evaluate the feasibility of routine BCRA in a diverse, publicly insured obstetrician gynecology clinic. Methods: All patients presenting to the obstetrician gynecology clinic were offered a BCRA using the Tyrer Cuzick (TC) risk model. Patients completed paper surveys and the information was input into the TC model to generate lifetime risk estimates. Printed evidence-based management guidelines were reviewed with and provided to those at ≥ 20% lifetime breast cancer risk and shared with the patient’s provider. Results: Between June 2023 and February 2024, 300 patients were approached and 208 (69.3%) completed the survey. One hundred seven (51.4%) survey respondents were presenting for obstetrical care and 101 (48.6%) for gynecologic care. Respondents had a median age of 33 years (IQR: 12). Ninety-six (46.2%) responding patients self-identified as Hispanic, 45 (21.6%) as Black, 25 (12.0%) as Asian, 28 (13.5%) as Non-Hispanic White, and 14 (6.7%) did not identify in these categories. One hundred eighty-nine (90.9%) survey respondents were publicly-insured. Ten (4.8%) patients were assisted by an interpreter. Overall, 12 (5.8%) patients had an elevated lifetime breast of breast cancer, defined as ≥ 20% based on the TC model (6 (50.0%) among obstetrical patients and 6 (50.0%) among gynecology patients). All patients at elevated risk were referred to a genetics clinic for counseling on options for enhanced breast surveillance. Conclusions: As leaders in women’s cancer care, gynecologic oncologists can lead and support programs to identify those women at highest risk for cancer, especially among historically underserved populations. Our feasibility study demonstrated that 69.3% of patients were willing to complete a BRCA and this tool identified 5.8% of patients to have a significantly elevated lifetime breast cancer risk. Providers should consider incorporating such tools in gynecologic oncology and obstetrical/gynecology clinics.
Overall survival in older patients with urologic cancer using G8 and G8m in a Brazilian cancer center.
Authors: Dettino Aldo A. , Modesto Ingrid Felix
Published: May 2024

e13760

Background: Aging is a significant risk factor for cancer, with a notable incidence among the elderly. To provide better assistance, international societies recommend the Comprehensive Geriatric Assessment (CGA), a multidisciplinary process aimed at developing a personalized treatment plan. However, CGA requires considerable time and specialized human resources, hindering its use in some healthcare systems. Also, CGA is not recommended for all older cancer patients. Current guidelines recommend the use of high-sensitivity screening tools, such as G8 and G8-modified (G8m), to identify those in CGA need. We aimed to verify the one-year overall survival associated with the G8 and G8m scores in patients aged ≥ 60 years with urological tumors. Methods: For this observational and prospective study, sociodemographic data were collected, G8 and G8m were applied to individuals aged ≥ 60 years with urologic cancer diagnosed within 6 months or prior to a change in therapeutic strategy, from Feb22 to Jan23. The occurrence of outcome (overall survival) was assessed in 1 year after these screening tools. Statistical analyzes were performed, such as mean, median, standard deviation and proportions, as well Kappa Coefficient to compare G8 versus G8m scores. Kaplan-Meier method was used to estimate one-year survival curves and Log-rank Test to evaluate the differences according to baseline scores from G8 (normal >14 or abnormal ≤14) and G8m (normal <6 or abnormal ≥6). Results: 58 participants were included, with a median age of 71 years old, and 93.1% of them were men. The most frequent cancer type was prostate (74.1%), followed by bladder cancer (13.8%). 45 patients (77.6%) were changing treatment strategy, and 13 (22.4%) received a diagnosis within 6 months. Most patients (70.7%) were stage IV. The G8 mean score was 13.5 (±2.6) and G8m, 7.9 (±7.2). A moderate agreement (77.8%) was found between normal G8 and G8m scores (Kappa = 0.551 and p <0.001) (Table). 9 individuals (15.1%) died within 1 year and all of whom had scored abnormally in G8 and G8m. The Kaplan-Meier estimator indicated that abnormal G8 and G8m scores impacted the one-year survival (p = 0.002, for both tools). Conclusions: In older patients with urologic cancer, G8 and G8m showed similar results in identifying patients with frailties who would require a CGA. In addition, this study indicates the predictive value of G8 and G8m for one-year overall survival in this setting. Therefore, our findings support the use of these geriatric screening tools in daily practice of Geriatric Oncology, optimizing treatment planning for older patients. [Table: see text]
Treatment outcomes and survival of patients with breast cancer aged 75 and older: A comparative study using propensity score-adjusted analysis.
Authors: Maeda Shigeto , Sugiyama Nozomu , Yoneda Akira , Kitasato Amane , Takeshita Hiroaki , Minami Shigeki , Kuroki Tamotsu
Published: May 2024

e13763

Background: With an aging society, the incidence of breast cancer among elderly patients is expected to rise. We aimed to explore treatment outcomes in breast cancer patients aged 75 and older at our institution. The lack of consensus on whether adjuvant therapy for elderly breast cancer patients should mimic that for younger patients prompted our investigation. Methods: We conducted a comparative study using data from 1553 breast cancer surgery cases (stage 0-3) treated between April 2007 and August 2021. Patients were divided into two groups: those aged 75 and older (n=184) and those aged 74 and younger (n=1369). Variables investigated included mean age, tumor size, stage, and subtype; surgical procedures and adjuvant therapies; overall survival (OS); and OS in the 75 and older group, considering the presence or absence of hormone therapy, and propensity score-adjusted OS. Results: Comparing the group aged 74 and younger with the group aged 75 and older revealed: Mean age: (55.5 years vs. 79.6 years), tumor size: (2.4 cm vs. 2.3 cm), stage (0/1/2/3) (%): (7.3/43.1/44.1/4/6 vs. 7.6/43.4/43.4/5.7), subtype (Luminal A/Luminal B/TN/HER2) (%): (60.0/16.7/11.3/7.9 vs. 63.5/10.7/15.7/5.7). Except for age, no significant differences were observed. Mastectomy (%): 45.9 vs. 50.8, axillary lymph node dissection (%): 33 vs. 22.3, adjuvant therapy (%): 93.2 vs. 65.7, adjuvant hormone therapy (%): 90 vs. 68, adjuvant chemotherapy (%): 68 vs. 14. The group aged 75 and older received significantly less adjuvant hormone therapy and chemotherapy. Kaplan-Meier 10-year OS rates: 90.3% vs. 77.5%, showing a trend toward lower survival in the group aged 75 and older, albeit not statistically significant. No significant differences were found in overall survival rates by subtype. In the group aged 75 and older, hormone therapy was omitted in 44.6% and administered in 55.4%, resulting in a significant difference in 10-year OS rates (63.5% vs. 84.7%). Following propensity score adjustment for age, stage, and subtype, the hormone therapy-free group exhibited a higher 10-year OS rate of 100%, in contrast to 84.7% in the hormone therapy group. Conclusions: Breast cancer cases in patients aged 75 and older show similar biological characteristics to those aged 74 and younger. The absence of adjuvant therapy does not impact OS, even though elderly patients aged 75 and older are less likely to receive adjuvant hormone therapy and chemotherapy.
Updated safety and efficacy analysis comparing elderly vs nonelderly patients treated with consolidation nivolumab or nivolumab plus ipilimumab after chemoradiation for unresectable stage III NSCLC from the BTCRC LUN 16-081 clinical trial.
Authors: Shahani Shobha , Althouse Sandra K. , Hanna Nasser H. , Durm Greg Andrew
Published: May 2024

e13770

Background: Lung cancer is the leading cause of cancer related deaths. The median age of those diagnosed with lung cancer continues to increase as the overall population ages. Consolidation immunotherapy after chemoradiation has become the standard treatment for patients with unresectable stage III NSCLC. However, little has been reported regarding the safety and efficacy of this strategy in an elderly patient population. Methods: Data was analyzed from a randomized phase II clinical trial in patients with unresectable stage III non-small cell lung cancer (NSCLC) who were randomized to Nivolumab (N) or Nivolumab/Ipilimumab (NI) after concurrent chemoradiation. We performed an ad-hoc analysis comparing the efficacy and toxicity based on age groups <65 and ≥ 65. A total of 54 patients received N (480mg IV every 4 weeks for up to 6 cycles) and 51 patients received N (240mg IV every 2 weeks) + I (1mg/kg IV every 6 weeks for up to 4 cycles). Results: From 9/2017 to 4/2021, 105 patients were enrolled. Fifty-five were age <65 (26 in N and 29 in NI) and 50 were ≥65 (28 in N and 22 in NI). Patients were matched for baseline characteristics (Table). In the N alone group, pneumonitis was noted in 14 patients: 9 (34.6%) <65 and 5 (17.9%) age ≥ 65 (p=0.16). In the NI group, 19 patients experienced pneumonitis: 9 (31%) were<65 and 10 (45.5%) were ≥ 65 (p=0.29). Hospitalization was noted in 9 patients in the N group: 6 (23.1%) < 65 and 3 (10.7%) ≥ 65 (p=0.28). In the NI group, 20 patients were hospitalized: 9 (31%) were <65 and 11(50%) were ≥ 65 (p=0.16). At 24 months, the PS for all patients <65 was 61.3% and 60.5% for patients ≥65(p=0.62). PFS was 46.8% for <65 and 73.8% for ≥65 (p=0.15) in the N group and 75.4% for <65 and 45.4% for ≥65 in the NI group(p=0.02). OS for patients <65 was 84% at 24 months and 73% for ≥65 for both groups (p=0.466). For individual groups, OS was 72.5% in <65 and 81.4% for ≥65 (p=0.27) in the N group and 92.8% for <65 and 68.2% for ≥65 in the NI group (p=0.029). Conclusions: Adverse events in both age groups were comparable but overall higher in NI arm in both younger and elderly patients. OS estimates were similar for both age groups in N while higher in younger patients compared to older adults in NI. [Table: see text]
Value of a multidisciplinary geriatric oncology committee on patient care in a community-based, academic cancer center.
Authors: Singh Gurbani , Morant Lena , Bedra McKenzie , Emel Jennifer , Harris Kelly , Markan Yudhishtra , deBorja Christopher , Tong Monica , Downs Patrice , Boutros Cherif
Published: May 2024

e13771

Background: The heterogeneity in health and functional ability among older patients makes the management of cancer a unique challenge. The Geriatric Oncology Program at the University of Maryland Baltimore Washington Medical Center (BWMC) was created to optimize cancer management and recommendations for older patients. This study aimed to assess the benefits of the implementation of such a program at a community- based academic cancer center. Materials and Methods: We retrospectively analyzed patients aged ≥80 years presenting to the Geriatric Oncology Program between January 2017 and July 2022. A multidisciplinary team of specialists collectively reviewed each patient using geriatric-specific domains and stratified each patient into one of three management groups- Group 1: those deemed fit to receive standard oncologic care (SOC); Group 2: those recommended to receive optimization services prior to reassessment for SOC; and Group 3: those deemed to be best suited for supportive care and/ or hospice care. ANOVA, chi-square, and Kaplan-Meier analyses were used to assess patient outcomes. Results: Among 233 patients included, 76 (32.6%) received SOC (Group 1), 43 (18.5%) were optimized (Group 2), and 114 (49.0%) received supportive care or hospice referral (Group 3). There was no significant difference in sex, race, or age among all three groups. The Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) score was implemented in 2019 (n=90). Patients receiving supportive/ hospice care only had an average score of 5.8, while the averages for those in the optimization and SOC groups were 4.6 and 4.1, respectively (p=< .001). SOC patients had the longest average survival of 2.71 years compared to the optimization (2.30 years) and supportive care groups (0.93 years) (p= <0.001). 69.8% of optimized patients were deemed fit for SOC upon re-evaluation following optimization services. For all patients that underwent surgical interventions, post- operatively, 23 patients (85%) were discharged home and 4 (15%) were discharged to a rehab facility. The average survival after surgery for all patients was 3.16 years, while patients who were optimized prior to surgery had an average survival after surgery of 3.21 years. Conclusions: The present study demonstrates the need for specialized consideration of the heterogeneity that cancer diagnoses present in older individuals. The Geriatric Oncology Program at BWMC is able to maximize treatment outcomes for geriatric patients through the provision of SOC therapies and optimization services, while also minimizing unnecessary interventions on an individual patient-centric level.
Breast cancer outcomes and treatment toxicity in geriatric patients compared to other patients at the Cancer Disease Hospital in Zambia.
Authors: Chitula Mwando Fidelia , Kizub Darya Aleksandrovna , Mwaba Catherine Kasongo , Msadabwe Susan Citonje , Mwala Kabisa
Published: May 2024

e13773

Background: Breast cancer is the second most common cancer in women in Zambia and the most common cancer in older women. Management of geriatric cancer patients can be challenging due to physiological changes and multiple comorbidities. Methods: Data was extracted from the CDH electronic database of breast cancer patients for November 2005 - November 2022. Geriatric patients were defined as those 65 years old or older. Data was analyzed using descriptive statistics. Clinical-pathologic characteristics and outcomes for geriatric (GP) and younger patients were compared using the Chi Squared Test/Fisher’s exact test for discrete and Student’s T-test for continuous variables. All p-values were two-sided. Results: Of 1981 patients, 493 (24.9%) were geriatric. 374 (18.9%) had Stage I/II cancer, 607 (30.6%) Stage III, 579 (29.2%) de novo Stage IV, with no differences between geriatric and younger patients. 441 (22.2%) had hormone receptor-positive (HR+) disease, 115 (5.8%) had HER2+ by IHC, 195 (9.3%) were triple-negative, 52 (2.6%) HR+HER2+. Geriatric patients were more likely to have invasive lobular carcinoma (4.6% v. 2.4%), less likely to have grade 3 (42.0% v 50.6%) or HER2+ (11.6% v 19.3%) cancer. 1889 (94.8%) received systemic treatment, 1188 (60.0%) surgery, and 844(42.6%) radiation (RT), with no differences in geriatric and younger patients. Geriatric patients were less likely to receive palliative RT (9.6% v 15.7%), to receive a lower total RT dose and had similar rates of RT dermatitis as younger patients. Geriatric patients were less likely to be treated with doxorubicin, docetaxel and more likely with methotrexate. After median follow-up of 1.1 years (st. dev 2.6), 301(15.2%) were alive without disease, 826 (41.7%) alive with cancer, 203 (10.2%) died from cancer, with no difference in local, distal recurrence, or survival for geriatric patients. Geriatric patients were less likely to be in good physical condition (33.9% v 39.4%) and more likely to have a worse ECOG (1.0% v 0.4% for ECOG 4, 4.1% v 2.4% for ECOG 3, 14.0% v 10.9% for ECOG 2, 73.4% v 75.8% for ECOG 1, 7.4% v 10.4% for ECOG 0). Geriatric patients had a lower number of total treatment toxicities (OR 0.95, 95% CI 0.91-0.98) and were less likely to have leukopenia (OR 0.89, 95% CI 0.83-0.94) and neutropenia (OR 0.88, 95% CI 0.82-0.95). (for similar outcomes p-value > 0.05; all where differences are noted p-value < 0.05). Conclusions: GPs were similar to other patients in terms of cancer stage and outcomes and had less aggressive disease. GPs had worse functional status, received less toxic chemotherapy, were less likely to receive surgery and RT. GPs had either a similar amount or less treatment toxicity compared to other patients. Results are limited by short follow-up of about 1.5 years. Results are limited by incomplete non-hematologic toxicity data.
Efficacy and safety of DOACs versus LMWH for elderly patients with active cancer: A meta-analysis.
Authors: Marinho Alice , Caldeira de Freitas Maria Carolina , Coelho Itaya Gabriela , Da Costa Larissa Maria , Lambert Fossen Eduardo , Celso Davi Said Gonçalves , Ferro Andre , Dias Yasmin , Vissotto Eduardo de Figueiredo , De Souza Mariana
Published: May 2024

e13776

Background: Anticoagulant treatment in patients with cancer aims to reduce the high risk of thromboembolism. Direct oral anticoagulants (DOACs) and low-molecular-weight heparin (LMWH) are currently approved for the treatment of cancer-related thrombosis. However, there is limited data comparing the efficacy and safety of these two antithrombotic therapies among elderly patients with cancer. Methods: PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were systematically searched for studies comparing DOACs with LMWH in cancer patients with newly diagnosed venous thromboembolism (VTE) or pulmonary embolism (PE). Both solid tumors and hematologic malignancies were included. Outcomes of interest were recurrent VTE and major bleeding. Odds ratio (OR) with 95% confidence intervals (CI) were pooled with a random-effects model. Statistical analysis was performed with Review Manager 5.4.1. Heterogeneity was assessed using the I2 statistic and chi-squared test. Results: Four studies, three randomized controlled trials (RCTs) and one observational, were included. A total of 3,266 patients older than 65 years who underwent anticoagulation with DOACs (35%) or LMWH (65%) were incorporated in the analysis. There was no statistically significant difference between anticoagulation therapies for recurrent VTE (OR, 0.68; 95% CI, 0.41-1.11; p = 0.13; I² = 56%; Table) or major bleeding (OR, 1.18; 95% CI, 0.61-2.25; p = 0.08; I² = 60%; Table). Conclusions: Our findings suggest no statistically significant differences in recurrent VTE or major bleeding between DOACs and LMWH in elderly oncologic patients with newly diagnosed VTE or PE. Given the practical challenges of using LMWH, DOACs may be considered an alternative anticoagulation strategy for these patients. [Table: see text]
Abemaciclib dose escalation to maintain intensity (ADE-MI).
Authors: Prescott Kevin , Gadi VK , Danciu Oana Cristina , Hoskins Kent , Ibraheem Abiola Falilat , Owens Jovonne , Chen Zhengjia
Published: May 2024

TPS618

Background: Abemaciclib is a an oral CDK4/6 inhibitor that is FDA-approved as adjuvant therapy for certain patients with early-stage HR+HER2- breast cancer in combination with endocrine therapy. The major toxicity of abemaciclib is diarrhea, which often occurs within the first 6-8 days of treatment initiation. Across several registrational trials, roughly 25% of patients with diarrhea from abemaciclib treatment required dose interruptions with roughly 20% required dose reductions. Because diarrhea happens early in the treatment course, one concern is this might dissuade people from continuing on or being fully adherent to adjuvant therapy. Incorporating strategies to minimize diarrhea may improve adherence and permit more patients to stay on the target recommended dose of 150mg BID for the full 2 years of adjuvant therapy. Our trial-in-progress evaluates dose escalation to address diarrhea as a cause of dose interruptions, reductions, and discontinuations, a strategy that has worked with other therapeutic agents. Specifically, our study tests the hypothesis that gradual up-titration of abemaciclib dose over a course of 4 weeks will decrease the rate of grade 3 or worse diarrhea. Methods: This is a post-marketing, single arm, phase IV trial for patients with high-risk early-stage HR+HER2- breast cancer who are eligible for treatment with adjuvant abemaciclib in combination with endocrine therapy. Fifty (50) subjects will be enrolled. Patients will gradually up-titrate the dose of abemaciclib over the course of 4 weeks before reaching the FDA recommended dose of 150mg BID (Table). The primary objective of this study is to increase the proportion of patients on the FDA recommended dose of abemaciclib at 3 months of treatment. At the significance level of 0.05, a minimum of 43 patients will achieve a power of at least 80% to detect the improvement (80% vs the historical control of 60%), using a two sized exact binomial test. Additional objectives are determining the number of days with greater than grade 1 diarrhea in the first month of treatment, determining rates of grade 3 or greater diarrhea, determining DFS and OS, and to assess patient reported outcomes regarding adverse events. The trial opened to enrollment on 12/21/2023. The first patient on the study was enrolled 1/25/2024. Clinical trial information: NCT06169371 . [Table: see text]
Tumor-Only Sequencing: A Story Only Half Told
Authors: Ceyhan-Birsoy Ozge , Stadler Zsofia K.
Published: May 2024

Germline testing and tumor sequencing are often both necessary for optimal cancer treatment and management.
The Hero of This Novel Is a Tree: Biocentric Narrative Strategies in Contemporary Eco-fiction
Authors: Archer Kirby
Published: May 2024

This article considers the novel's possibilities for depicting and responding to the climate crisis by analyzing Richard Powers's efforts to write a biocentric perspective in The Overstory (2018). In biocentric narratives, humans, typically the focal point of the novel, are decentered in favor of perspectives that attempt to encompass more of the living world. Efforts to evade narrative anthropocentrism, which are often encouraged by ecocritics, may not offer an effective frame through which to articulate the climate crisis. The article defends narrative anthropocentrism against the charge that it is unambiguously problematic and challenges the claim that it is potentially avoidable through the adoption of a theoretically biocentric narrative perspective. Rather, strategic awareness of narrative anthropocentrism can help novelists foster visions of strong connections to our environments and inspire reader engagement with environmental concerns. Powers's effort to move beyond anthropocentrism, which is motivated by positive intentions to impact reader interest in environmental issues, is stymied by the inevitability of the human perspectives and interests that attend the construction of any narrative. The article concludes that some instances of anthropocentrism in novels like The Overstory, in which Powers cannot altogether supplant anthropocentrism with a biocentric perspective, are more constructive and positive vis-à-vis nonhuman nature and the environment than others, such as Powers's portrayal of reverence for nonhuman nature. If reverence reveals the attachment of human values and emotions to nonhuman entities, it suggests how anthropocentrism might be harnessed for the benefit of the wider environment.
In Default of Providence: Tragedy and Tess of the d'Urbervilles
Authors: Rolland Anick S.
Published: May 2024

Reconsidering Thomas Hardy's Tess of the d'Urbervilles: A Pure Woman in view of newly discovered textual discrepancies between editions and critical scholarship, this essay makes a necessary intervention in the reading tradition of the rape-fall-punishment triad by shifting the central event of the novel to the murder as it relates to aspects of the novel's religious framework. It argues that Tess's actions are contingent on a critical phrase, “a shining light,” that has been suppressed through the novel's complicated publication history and reconnects sections of the plot to restore the significance of tragedy in the novel without explaining that tragedy through her violation. By recovering the religious significance of conversion in the text as crucial to a structure of extralegal justice on which the events of the novel hinge, the essay argues that Tess's crime, rather than serving as mere irony, is motivated by faith and an understanding of justice that illuminates the problem of the uncanny God of the nineteenth century, present through absence. As the salvation plot is brought back into relevance with the marriage plot, the concept of Tess's love as a powerful force that should be able to overcome all is reduced to a failed attempt at epistemic reform. Through her failure, the novel raises questions about the possibilities of radical world-making that have historically been overlooked by Hardy's critics.