bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers to clinical trial enrollment of older adults with cancer: A systematic review.
Authors: Sedrak Mina S. , Hurria Arti , Li Daneng , George Kevin , Padam Simran , Liu Jennifer , Wong Andrew R. , Vargas Noel , Eskandar Joy , Katheria Vani , Mortimer Joanne E. , Mohile Supriya Gupta , Dale William
Published: May 2019

e18130

Background: Despite the disproportionate impact of cancer on older adults, older patients are vastly underrepresented in clinical trials that set the standards for cancer treatment. To better understand the reasons for this disparity, we conducted a systematic review of studies that have specifically examined barriers and interventions to improve clinical trial enrollment of older adults with cancer. Methods: We conducted a comprehensive two-step search strategy. First, we consulted an information specialist to develop an electronic search for the following databases from inception to January 15, 2019: PubMed, Ovid/Medline, Embase, Scopus, PsycINFO, and Cochrane library. Second, references of retrieved key articles were screened for relevant studies. Two authors then independently reviewed all titles and abstracts (N = 10,985) and examined studies for full text eligibility (N = 221). Inclusion criteria were: 1) original research; 2) study assessed barriers and/or interventions to enrollment in oncology clinical trials; 3) included patients ≥ 60 years with cancer. Narrative reviews and abstracts without full text were excluded. Data was extracted by independent raters and summarized using a qualitative analysis software, NVivo v12. Results: 12 observational studies examining barriers and 1 randomized intervention were included. Barriers were assessed at the patient level (N = 5 studies), healthcare professional (HCP) level (N = 5), and both patient and HCP levels (N = 2). Stringent eligibility criteria (N = 7) and oncologists’ concerns for toxicity (N = 7) were the most common barriers cited. Patient barriers included transportation (N = 6), time/burden (N = 6), and awareness (N = 6). Although caregiver barriers (N = 4) were identified, none of the studies examined caregiver perceptions. One study evaluated a physician-directed educational intervention and found no significant impact on accrual of older adults. Conclusions: Although several studies have examined the barriers to accrual of older adults with cancer, only one intervention study has attempted to address these barriers. Given the aging of the cancer population, new strategies for including older adults in cancer clinical trials are critically needed.
Barriers and facilitators to oncology clinical trial accrual: Comparing perceptions of community and academic oncologists.
Authors: Wong Andrew R. , Hurria Arti , Sun Virginia , Li Daneng , George Kevin , Liu Jennifer , Padam Simran , Katheria Vani , Waisman James Ross , Mortimer Joanne E. , Mohile Supriya Gupta , Dale William , Sedrak Mina S.
Published: May 2019

e18131

Background: Multiple studies have described the barriers and facilitators to oncology clinical trial accrual in academic practices. However, few studies have been done in community settings, even though the majority of patients with cancer receive their care in the community. We examined and compared community and academic oncologists’ perceptions of the barriers and facilitators to cancer clinical trial accrual. Methods: Semi-structured interviews were conducted from March to June 2018 with 44 medical oncologists at City of Hope (24 in academia; 20 in community sites). Purposive sampling was used to ensure participant diversity. Primary measures were oncologists’ self-reported perceptions of the barriers and facilitators to clinical trial accrual. Responses were recorded digitally, transcribed, and de-identified. Data was managed using NVivo v12. Two analysts coded the interview data using thematic content analysis (kappa = 0.74). A third analyst adjudicated discrepancies. Results: Of the 44 participants, 36% were women, and 68% had > 10 years of experience. Compared to academic oncologists, community oncologists more often cited barriers due to the lack of protocols suitable for community patients’ histology and stage (13% vs. 6%) and insufficient trial personnel support (13% vs. 9%). Compared to community oncologists, academic oncologists more often cited barriers due to limited time (14% vs. 8%) and overly stringent eligibility criteria (14% vs. 9%). Community oncologists more commonly reported extrinsic facilitators (e.g. reminders of available protocols from trial support staff) (91% vs. 76%) while academic oncologists more commonly reported intrinsic facilitators for offering clinical trials (e.g. self-motivation to prioritize clinical trials) (24% vs. 9%). Conclusions: Community oncologists more often reported facing barriers to accrual due to limited suitable trials and insufficient personnel support compared to academic oncologists. Additionally, community oncologists cite the need for more infrastructure to support accrual. Interventions to increase trial accrual must be tailored to address the unique needs of both community and academic practices.
Modeling accrual of older adults to cancer clinical trials: (Alliance A151736).
Authors: VanderWalde Noam Avraham , Wakefield Daniel Victor , Satele Daniel V. , Dockter Travis , Sloan Jeff A. , Jagsi Reshma , Lichtman Stuart M. , Freedman Rachel A. , Lafky Jacqueline M. , Muss Hyman B. , Cohen Harvey Jay , Hurria Arti , Jatoi Aminah , Le-Rademacher Jennifer
Published: May 2019

e18132

Background: Older adults (65+ years) make up > 50% of cancer patients in the US,1 yet, older patient enrollment onto trials remains < 30%.2 This study’s aim was to determine the association between trial level variables and accrual rates of adults 65+ to better design trials that can more improve enrollment of these patients. Methods: We analyzed enrollment percentages of patients age 65+ in non-age specific Alliance trials with > 50 patients, that completed accrual between 1995- 2015. Enrollment percentage by 65+ for each study was compared to cancer incidence percentage by 65+ according to the Surveillance, Epidemiology, and End Results (SEER) Program for the same time periods. Enrollment Disparity Difference (EDD)3, defined as the difference between SEER incidence percentage of patients 65+ and the trial percentage enrollment of 65+ was calculated for each trial ( SEER % – trial %). Univariate analyses (UVA) were performed using simple linear regression to determine trial variables associated with larger EDDs (higher disparity). Variables that had an F-test p-value < 0.20 were included in a multivariable fixed-effects linear model for multivariate analysis (MVA). Results: Median age of 66,708 patients across 237 trials with 10 cancer types was 60 years. Average % of 65+ in trials was lower than average SEER comparison % 65+ per trial (37.6% vs. 57.8%). The median trial EDD, was 16.7%. On UVA, cancer type was significantly associated with higher EDD (see Table). Use of fewer modalities (1, 2, vs 3+) was associated with lower estimated EDDs (1 = -11 [+/-3.6], 2 = -8.9 [+/-3.9], F-test p = .012). On MVA, non-genitourinary (GU) cancer type, number of treatment modalities, and the phase (II or III compared to observational/other) were all significantly associated with higher EDD. Conclusions: Older adults were under-represented in this large sample of trials. This information can be used as a platform to better design disease-specific trials to improve older patient accrual, particularly in disease areas which are under-performing. Support: U10CA180821, U10CA180882, UG1CA189823: https://acknowledgments.alliancefound.org . References: 1. Smith BD et al. J Clin Oncol 27:2758-65, 2009; 2. Hurria A, et al. J Geriatr Oncol 1:40-44, 2010; 3. Pang HH, et al. J Clin Oncol, 2016.[Table: see text]
Disparities in survival by insurance status in chronic lymphocytic leukemia.
Authors: Mohammed Kahee A. , Al-Hammadi Noor , Hamieh Lana , Osazuwa-Peters Nosayaba , Hinyard Leslie J.
Published: May 2019

e18134

Background: Chronic Lymphocytic Leukemia (CLL) is the most common leukemia in western world. It is the disease of older adults with a median age at diagnosis of approximately 70 years. However, significant proportion of younger adults are diagnosed with CLL and they usually have an adverse clinical and molecular risk profile necessitating early interventional strategies compared to older patients. Socioeconomic disparities may affect survival for some patient populations. This study examined survival by insurance status for younger patients with CLL. Methods: The Surveillance, Epidemiology, and End Results database was used to identify patients, aged 15 - 64 years, who were diagnosed with CLL between 2007 and 2014 and whose insurance status (no insurance, Medicaid, and other insurance) was documented at diagnosis. Unadjusted associations between insurance status and overall survival (OS) were plotted using Kaplan-Meier curves. The association between insurance status and CLL-specific mortality was assessed using multivariate Cox proportional hazards regression models, adjusting for sociodemographic covariates. Results: A total of 10,913 patients with CLL were included with a median follow up of 44 months. Five-year survival estimates were 87.3%, 87.2%, and 94.0% for patients with no insurance, Medicaid, and other insurance, respectively. In multivariate analysis, compared to patients with other insurance, patients with no insurance (hazard ratio [HR] = 2.33, 95% confidence interval [CI] = 1.73 – 3.140) and Medicaid (HR = 1.95, 95% CI = 1.49 – 2.54) had significantly worse OS survival after adjusting for sociodemographic factors. Conclusions: Younger patients with no insurance or Medicaid have lower survival outcomes after diagnosis with CLL compared to patients with other insurance. Addressing barriers to care, providing resources, and expanding access to care is paramount to reducing the gap in survival for the uninsured patients and those with lower socioeconomic status. Further studies are needed to address poor survival outcomes among Medicaid patients.
Contributive compared with subsidized insurance in colorectal cancer in the Colombian National Administrative Cancer Registry.
Authors: Hsu Robert , Ramirez Paula , Acuña Lizbeth , Lopes Gilberto
Published: May 2019

e18136

Background: Colombia has gone to great lengths to provide nearly universal health care insurance for its patients, as 96.6% of its constituents now have health insurance as of 2014 compared to 23.5% in 1993. Most Colombians are associated with either contributive insurance (CI) in which employees and employers contribute to the insurance or subsidized insurance (SI) in which government funds cover the insurance cost. Colorectal cancer (CRC) has the 5th highest incidence of all malignancies in Colombia. This abstract aims to compare CRC care delivery metrics between CI and SI. Methods: We used the Colombian National Administrative Cancer Registry (NACR) data compiled from the Department of Health Ministry from January 2, 2016- January 1, 2017 consisting of 32 departments and 1122 municipalities. CRC cases were investigated by incidence, mortality, percentage of cases with early stage detection, stage I-III with curative surgery intent, nutritional support, and TNM staging, and days between suspicion to diagnosis, diagnosis to first treatment, neoadjuvant therapy to surgery, and surgery to adjuvant therapy. Results: There were 2605 new CRC cases in the NACR in 2017, with 1691 CI cases and 823 SI cases. There was a noticeably higher incidence in CI (7.2 new cases per 100,000 people) than in SI (3.7 new cases per 100,000), and a higher mortality rate (5.0 deaths per 100,000) in CI compared with SI cases (2.6 deaths per 100,000). There was a significant increase in average wait time for SI CRC cases from diagnosis to first treatment (77.7 days vs. 57.3 days, p = .027) and in average time to neoadjuvant therapy to surgery in CI cases (123.1 days vs. 92.5 days, p = .054) with longer but statistically insignificant wait times in SI cases in average time to adjuvant therapy (83.6 days vs. 73.9 days, p = .0168) and suspicion to diagnosis (56.1 days vs. 46.9 days, p = .811). Similar percentages of CI and SI cases had early stage detection (37.2% in SI vs. 34.3% in CI, p = 0.311), TNM staging (50.7% in CI vs. 49.3% in SI, p = 0.146), stage I-III cases with curative surgery intent (23.3% in CI vs. 21.8% in SI, p = 0.833), and nutritional support (10.5% in CI vs. 8.5% in SI, p = 0.942). Conclusions: The NACR represents a model for developing countries to improve cancer care delivery efficiently. As evidenced by higher incidence and mortality in CI cases and longer wait times before treatment in SI cases, there are differences in cancer care delivery between major modes of healthcare delivery in Colombia. More investigation needs to be done with a goal of streamlining cancer care delivery.
Delays in diagnosis in young patients with leukemia and lymphoma.
Authors: Winestone Lena , McPheeters Jeffrey , Puccetti Diane , Wilkes Jennifer Jill , Muffly Lori S. , Kahn Justine , Henk Henry J. , Ginsberg Jill P. , Keegan Theresa , Pollock Brad H. , Alvarez Elysia Marie
Published: May 2019

e18138

Background: Patients diagnosed with leukemia and lymphoma typically present with nonspecific symptoms, making a timely diagnosis difficult. Little is known about factors associated with delays in diagnosis. We hypothesized that age, minority race/ethnicity, and low income are associated with greater time to diagnosis. Methods: Using the OptumLabs Data Warehouse, which includes claims data for privately insured enrollees in a large US health plan, we identified 17,536 pediatric (0-14 y), adolescent (15-21 y), and young adult (22-39 y) patients diagnosed with acute leukemia or lymphoma between 2001-17. Using this retrospective cohort, potential cancer-related symptoms occurring up to 6 months pre-diagnosis were identified. Delay was defined as > 3 months from symptom onset to diagnosis. Contingency table analysis with chi-squared tests and unconditional logistic regression were used to estimate the association between sociodemographic factors and delays in diagnosis. Results: Seventy-eight percent of patients had a diagnosis of a cancer-related symptom in the 6 months prior to diagnosis. The most common presenting symptoms were lymphadenopathy, fever, and cytopenias. The median days to diagnosis was longer in young adults (93) than children (86) or adolescents (81) (p = < 0.0001). For pediatric v. AYA patients, median days to diagnosis differed for those with constitutional symptoms (18 v. 37, p = < 0.001), infectious symptoms (93 v. 74, p = < 0.001), and cytopenias (11 v. 22, p = < 0.001). Multivariable analysis identified younger age, female sex, and low household income to be significantly associated with delays in diagnosis (table below). Conclusions: In this large cohort of privately insured patients, adolescents had the shortest time to diagnosis. We saw no disparities by race/ethnicity or education but observed that low income ( < $40K) and female patients had greater odds of delays in diagnosis. [Table: see text]
Worse outcomes associated with public insurance at sarcoma diagnosis in adolescent and young adults (AYAs).
Authors: Alvarez Elysia Marie , Maguire Frances , Parsons Helen M. , Morris Cyllene , Parikh-Patel Arti , Malogolowkin Marcio H. , Wun Ted , Keegan Theresa
Published: May 2019

e18143

Background: Studies have shown that having public or no insurance at sarcoma diagnosis is associated with higher stage disease and poor survival. However, previous studies have not differentiated sarcoma patients who enrolled in Medicaid at diagnosis from those previously insured, groups with differing access to care. Therefore, we examined the impact of insurance on stage at diagnosis and overall survival for AYAs with soft tissue sarcoma (STS), osteosarcoma (OS) and Ewing sarcoma (EWS). Methods: Using Medicaid enrollment data linked to the California Cancer Registry, we identified AYAs with STS (n = 1782), OS (n = 458), and EWS (n = 348), diagnosed during 2005-14. Insurance was classified as Medicaid [1. Continuous (≥5 months prior to diagnosis), 2. Discontinuous, 3. At diagnosis (no coverage prior to diagnosis)], private, and uninsured. Logistic and Cox proportional hazards regression determined the association of insurance with metastatic stage (vs localized) and overall survival, respectively adjusting for sociodemographic factors, baseline comorbidities, type of facility, treatment (survival) and stage (survival). Results: Only 17.5% of sarcoma patients had continuous Medicaid prior to diagnosis, with 11% of STS, 17% of EWS and 19% of OS patients obtaining Medicaid at diagnosis. AYAs with Medicaid at diagnosis [Odds Ratio (OR) 3.03, 95% Confidence Interval (CI) 2.27-4.03; vs private] and discontinuous Medicaid (OR 2.25, CI 1.48-3.41) had a higher likelihood of metastatic disease. STS patients with Medicaid at diagnosis [Hazard Ratio (HR) 1.83, CI 1.44-2.33; vs private) and discontinuous Medicaid (HR 1.45, CI 1.01-2.08) had worse survival. Medicaid at diagnosis (HR 1.68, CI 1.07-2.63) also was associated with worse survival in OS patients, but this association was not observed in EWS patients. Conclusions: Lacking insurance prior to diagnosis is associated with metastatic disease at presentation and worse survival in AYA patients with sarcoma. Health insurance remained associated with worse survival even after adjusting for stage, highlighting the importance of continuous health insurance to improve outcomes for this patient population.
Evaluation of racial disparities in the treatment of United States veterans with pancreatic cancer.
Authors: Thomas Theodore Seth , Luo Suhong , Keller Jesse W. , Sanfilippo Kristen Marie , Carson Kenneth Robert
Published: May 2019

e18148

Background: Recent studies have demonstrated racial disparities in pancreatic ductal adenocarcinoma (PDAC) treatment. Black patients with PDAC are less likely to undergo surgery or receive systemic therapy compared to white patients. One explanation for this may be access to healthcare. The aim of this study is to evaluate racial disparities in treatment of PDAC patients in a cohort of United States Veterans with equal insurance access. Methods: This study is a multicenter, retrospective cohort study. The VA Central Cancer Registry was used to identify patients diagnosed with PDAC from Oct 1st, 1998-Dec 31st, 2014. This cohort was divided into surgically resected and advanced/unresectable groups. The primary outcome for the surgery cohort is the association between race and receipt of adjuvant therapy. The metastatic cohort includes patients with stage III/IV without surgery record. The primary outcome is the association between race and recorded chemotherapy within 6 months of diagnosis. Primary outcomes were assessed using multivariable logistic regression controlling for age and comorbidities. Associations between race and survival for each sub-cohort were assessed using cox proportional hazards analysis. Results: The surgery cohort consisted of 1,835 patients of whom 356 (19%) were black and 1,433 (78%) were white, with 660 (36%) receiving adjuvant treatment. There was no association between race and receipt of adjuvant treatment (OR 1.00, 95% CI 0.78-1.28). There was no difference in survival up to 3 years in white patients compared to black patients (HR 0.99, 95% CI 0.86-1.14). The metastatic disease cohort consisted of 7,983 patients of whom 1,610 (20%) were black and 6150 (78%) were white, with 2,885 (36%) receiving chemotherapy. There was no association between race and receipt of chemotherapy in patients with advanced disease (OR 1.02, 95% CI 0.91-1.15). There was no difference in survival up to 1 year in white patients compared to black patients (HR 0.96, 95% CI 0.90-1.01). Conclusions: This study failed to demonstrate an association between race and adjuvant therapy or systemic therapy administration. There was no difference in overall survival in this cohort. Previously described racial disparities in the treatment of advanced PDAC do not extend to the equal insurance access VA Health Care System.
Evaluating use of interpreters in educating immigrants on cancer prevention and screening guidelines.
Authors: Bulone Linda , Korc-Grodzicki Beatriz , Gangai Natalie , Manna Ruth , Costas-Muñiz Rosario , Kemeny Margaret
Published: May 2019

e18149

Background: Community outreach is commonly used to disseminate cancer prevention & screening guidelines (CPSG). Minority, immigrant populations with language barriers tend to be excluded from these activities due to the lack of bilingual professionals available to deliver this education. This program was aimed to test whether CPSG education improves knowledge after being taught by an English-speaking medical professional and nonmedical, community-based interpreters working in South Asian and Hispanic communities in New York City (NYC). Methods: Team members from two cancer centers and community-based minority organizations in NYC partnered to create and deliver programs on CPSG to linguistically diverse communities by an English-speaking medical professional utilizing community-based interpreters. Participant knowledge was assessed using matched pre-post surveys in participants’ respective languages. Behavioral intention was measured using a Likert scale from 1-4 with anchors at 1) “Will not do it” and 4) “Already have/doing it”. Paired t-tests were used to compare pre to post mean score and a p-value < 0.05 was considered statistically significant. Behavioral intention rated positively if participants endorsed “will do it” or “already doing” the healthy behavior. Results: 188 community dwelling adults participated in 5 educational sessions, 122 completing pre and post assessments. Median age was 68, two thirds (69%) were female. 94% were born outside of the US, coming from 12 different countries, speaking 6 different primary languages. Knowledge increased from an average of 33% correct responses pre-session to 63% correct post-session – a statistically significant change ( t (121) = -10.58, p < .001). Behavioral intention scores reveal 83-96% participants reporting they will continue to or plan to seek screening and screening information from their doctors as well as make lifestyle changes related to decreasing their cancer risk. Conclusions: This program demonstrates CPSG can not only be taught in English with use of interpreters, but can be successfully received by immigrant community participants who historically may not have these programs available to them due to language barriers.
Healthcare disparities among cancer patients in the emergency department: How do race and ethnicity affect bounce-back rates?
Authors: Coyne Christopher John , Shatsky Rebecca Arielle , Brennan Jesse , Martinez Elena
Published: May 2019

e18150

Background: Previous studies have demonstrated that patients with cancer utilize the emergency department (ED) more frequently than the general population. Additionally, cancer patients are more likely to require a repeat ED visit within 7 days of a preceding ED discharge (bounce back). This may be a marker of inadequate care or missed diagnosis. We designed this study to evaluate whether there are differences in bounce-back rates among cancer patients of different races/ethnicities. Methods: We performed a retrospective cohort study to compare all cancer-related ED visits in California based on race/ethnicity using the Office of Statewide Health Planning and Development (OSHPD) database. We queried all cancer-related ED visits in 2016 among patients ≥18 years and recorded general demographics. Our outcome measures were bounce-back rate and admission rate on the second ED visit. All data were analyzed using SPSS software and descriptive statistics are reported. Results: In 2016, there were 73,465 patients with 103,523 cancer-related ED discharges that met study inclusion criteria. 18% (18,491 visits) of these visits resulted in a bounce-back (versus 13.3% in the general ED population). African American patients had the highest bounce-back rate at 19.5%, followed by Hispanics (18.9%), Non-Hispanic Whites (17.3%) and Asians (17%). We observed an inverse trend in admission rates on the bounce-back visit, with Asian patients having the highest admission rate (40.5%), followed by Non-Hispanic Whites (37.7%), Hispanics (35.1%), and African Americans (32.5%). This is in the context of an overall admission rate of 36.7%, and a high mortality rate on the bounce-back visit of 8.4%. All groups were similar with respect to age, gender, and disease burden. Conclusions: Overall, we observed that African Americans and Hispanics returned to the ED at rates above average, which may be a marker of inadequate care or misdiagnosis. Furthermore, these groups were discharged at a higher frequency on the second visit, despite the high mortality associated with a bounce-back visit. Further investigation is needed to identify actionable targets to improve the emergency cancer care of all races/ethnicities.
Are two sites better than one?: Sites of care and quality of myeloma treatment.
Authors: Renteria Anne , Jagannath Sundar , Fei Kezhen , Lin Sylvia , Yagnik Radhi , La Lisa , Lin Jenny J. , Bickell Nina A.
Published: May 2019

e18159

Background: Care coordination affects the quality of cancer treatment. Multiple Myeloma (MM) patients frequently are cared for by local and referral center physicians. We sought to determine whether getting treated at different sites might impact on the quality of MM care. Methods: We used NCCN 2014 and CMS guidelines to define categories of treatment quality and transplant eligibility. We defined high quality MM care as: Induction for all patients with ECOG < 4; harvest & transplant for patients completing induction without progression, with albumin > 2.8, bilirubin < 3 and age ≤77 years; maintenance for transplant ineligible patients completing induction with no progression & for transplant eligible patients completing transplant with no progression; and supportive care of receiving bone targeting agents, anticoagulation and infection prophylaxis for all patients receiving MM therapy. Patients who received care with both local and referral center physicians were considered to have received care at 2 sites. We abstracted 709 charts of patients with ICD-9 diagnosis of MM from 2010-2014 for demographics, site of care and treatments received. We compared groups with chi square and multivariate logistic regression models with age, insurance, race, comorbidity and sites of care to predict care quality. Results: Of the 709, 388 had active MM. On average, patients were 62 ±11 years. Overall, 70% received care at > 1 site. Referred patients had no differences by age, comorbidity index, insurance or race. Having > 1 care site was associated with higher rates of induction and harvest. Conclusions: Historically, hand-offs in care have been associated with poorer quality. However, in a referral center, hand-offs do not negatively affect induction and harvest care quality. Patients referred to a MM center are more likely to get high quality treatments for which they are referred, but referral does not ensure receiving the full gamut of needed MM treatments.[Table: see text]
Survival trends in elderly patients with malignant mesothelioma: An analysis utilizing Surveillance, Epidemiology, and End Results database.
Authors: Arjyal Lubina , Vallatharasu Yazhini , Bista Amir , Ojelabi Michael Olayiwola
Published: May 2019

e18164

Background: Malignant mesothelioma is a highly aggressive tumor arising from the mesothelial surface. Treatment for malignant mesothelioma has not changed significantly in recent years. Better patient care may have improved survival in malignant mesothelioma patients. We conducted this study to evaluate the relative survival rates in elderly patients with malignant mesothelioma over the last one and half decades in the United States. Methods: Elderly patients (age≥65 years) diagnosed with malignant mesothelioma were selected from the Surveillance, Epidemiology, and End Results (SEER-18) database. We used Z-test to compare 1- year relative survival rates (RS) between the two time frames: 2000-2009 and 2010-2014. Several cohorts categorized by race (Caucasians and African-Americans) and gender were stratified. The survival rates were accompanied by standard errors. Results: In total, the SEER-18 database identified 6,346 patients (4,210 from 2000-2009 and 2,136 from 2010-2014; 78.3% were males, 92.6% were Caucasians). Overall, there was no improvement in survival in recent years (1-year RS: 35.4 ± 0.8 vs 36.5 ± 1.2, Z score = 1.910 on 2000-2009 & 2010-2014 respectively). This was true for most of the cohort including those for males: 1-year RS: 35.0±0.9 vs 36.1±1.3, Z score = 1.569; females: 1-year RS: 37.0±1.7 vs 37.8±2.5, Z score = 1.116 and Caucasians: 1-year RS: 35.8± 0.8 vs 36.6.± 1.2, Z score = 1.512 on 2000-2009 & 2010-2014 respectively. There was significant improvement in relative survival among African Americans: 1-year RS: 25.3±3.6 vs 38.6±5.6, Z score = 2.362. Conclusions: Our analysis of real-world data showed an improvement in relative survival rates for African American patients with malignant mesothelioma in recent years. This is likely related to improved delivery of care. Overall prognosis continues to remain poor and there is a strong need for novel therapeutic agents.
Liver cancer systemic treatment patterns in the largely rural state of New Mexico.
Authors: Cadavid Natalia , Anselmo Lisa M. , Maestas Erika , Soares Heloisa P.
Published: May 2019

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Background: New Mexico (NM) has one of the highest rates for hepatocellular carcinoma (HCC) in the US. Systemic therapy (ST) for HCC is typically reserved for patients with unresectable or metastatic disease. Sorafenib has been commonly used as the first-line (1L) systemic agent for HCC after its FDA-approval in 2007. Since 2017, several other agents have been FDA-approved for HCC including lenvatinib as 1L therapy and regorafenib, cabozantinib, ramucirumab and checkpoint inhibitors (nivolumab and pembrolizumab) as second-line (2L) treatment options. This retrospective study describes the HCC treatment patterns of patients seen at the University of New Mexico Comprehensive Cancer Center (UNMCCC). Methods: Following approval by the institutional review board, a retrospective chart review of all consecutive HCC patients at the UNMCCC between January 1, 2012 and August 30, 2018 was performed. Patients were identified accessing the UNMCCC tumor registry database. Data on patients’ characteristics, treatments and outcomes were collected. Descriptive statistics were conducted for this initial analysis. Results: A total of 99 of the 380 patients seen at the UNMCCC within the study period were considered for systemic therapy. Most patients were males (82.8%) and of Hispanic/Latino (57.6%) ethnicity. The majority of patients had one or more risk factors for HCC including a history of hepatitis (70.7%), cirrhosis (70.7%), and history of alcohol use (72.7%). Child Pugh class A and B were seen in 30.3% and 44.4% of patients, respectively. Ninety-six patients were prescribed sorafenib initially; however, only 67 patients (70%) successfully initiated treatment. The median time between sorafenib prescription and treatment initiation was 15 days. Only fifty percent of patients started sorafenib with the FDA-recommended dose of 400mg PO BID. Commonly reported adverse events were fatigue, diarrhea, hand and foot syndrome and LFT elevation. After 2017, when 2L options became available, 11 of 27 patients that started on sorafenib continued on to 2L (9 patients received nivolumab and 2 patients received regorafenib). Outcome data are currently being analyzed and will be reported. Conclusions: Although systemic options are available for the treatment of HCC, a significant number of patients are still not accessing and receiving treatment. A detailed analysis of factors affecting treatment patterns in New Mexico is warranted.
Arabic and Assyrian immigrants’ knowledge of hepatitis and liver cancer in Sydney, Australia. Findings of a community consultation process.
Authors: Robotin Monica Cristina , Gallego Gisselle , Mansour Zeinab , Masgoret Ximena , Wallace Jack , George Jacob
Published: May 2019

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Background: In Australia over 50% of hepatocellular cancers (HCC) are diagnosed in immigrants born in viral hepatitis endemic areas. Therefore, increasing community awareness of viral hepatitis as a preventable and treatable cause of liver cancer is critical in designing community-based cancer prevention programs. Although 7% of Australians living with chronic hepatitis B (CHB) were born in Africa or the Middle East, limited information exists about these communities’ knowledge and beliefs around hepatitis and cancer. To assist the design of effective strategies for screening and treatment, we conducted a community consultation process among Arabic and Assyrian-speaking communities in Sydney, Australia. Methods: The consultation involved semi-structured interviews with key opinion leaders in the Arabic and Assyrian communities and focus group discussions (FGD) conducted in Arabic, Assyrian and English with community members. Interviews and discussion were digitally recorded, translated and transcribed. Framework analysis was employed for data analysis. Results: Twelve face to face semi-structured interviews were conducted with Arabic and Assyrian community leaders. Sixty-six participants, aged from 22 to 71 years took part in seven FGDs. Findings were highly confluent and highlighted a limited knowledge and understanding of hepatitis and of links to liver cancer. Hepatitis and cancer are stigmatising diseases and kept within the family. To mitigate the distress brought about by cancer, euphemisms and protective language are used and a cancer diagnosis is not disclosed to family members. Communities’ ability to engage with the health system is limited. Fear and past medical interactions influence decision about accessing care and education levels, health literacy and English proficiency are significant barriers to navigating the health system. The internet, doctors, television and radio are the communities’ main sources of health information. Conclusions: Reluctance to talk openly about hepatitis and cancer and widespread ‘cancer fatalism’ need to be considered in clinical interactions. Health information messages need to be tailored to patients’ cultural beliefs, couched in accessible terms and delivered through a range of communication channels.
Incidence patterns of early onset colon cancer by race and stage in the US.
Authors: Shah Nishi , Acuna-Villaorduna Ana , Goel Sanjay
Published: May 2019

e18168

Background: Several studies show that incidence of colorectal cancer is increasing among young individuals. However, information on incidence of early onset colon cancer by race and stage is lacking. Methods: We analyzed incidence of colon cancer using National Program of Cancer Registries database which covers 99% of the US population. We identified colon cancer using ICD-O-3 code 8000-9049, 9056-9139, 9141-9589, along with the variable for site from cecum to sigmoid colon for years 2001 to 2015. SEER*Stat was used to calculate age-adjusted rates, trends and annual percent change. Results: Age adjusted incidence rate for colon is 31.2 cases per 100,000 among the entire population. Incidence in the age group of 15-39 years, 40-49 years, 50-59 years, 60-69 years, 70-79 years, 80+ years is 2.4, 14.3, 39.8, 86, 165.8, 232.3 per 100,000 respectively. The distribution of colon cancer by race for age groups is listed in table. When evaluating the incidence trend in each race for early onset colon cancer, the trend shows a rise in whites for both age groups (Annual Percent Change [APC] 3.4%, 1.5% for 15-39 years, 40-49 years of age respectively, p < 0.05). The trend in blacks on the other hand shows a rise of 1.2% (p < 0.05) in 15-39 years of age and a small but statistically significant decrease in incidence in 40-49 years of 0.5% (p < 0.05). In Asian Pacific Islanders (API) and American-Indians or Alaskan Natives (AI), the trend is not significant for either age groups. In the age groups above 50 years, the trend shows a decrease in incidence of colon cancer in all races. The rise in incidence for colon cancer in 15-39 years age group appears higher in localized disease as compared to metastatic disease (6.5% vs 2.8% for localized vs distant site of disease). Conclusions: This study highlights differences in incidence of early onset colon cancer among young patients by race and stage. Although there have been more cases of early onset colon cancers in blacks, the rise in incidence is higher in whites. With colonoscopy, there has been decrease in incidence of colon cancer for patients > 50 years for all races and stages. [Table: see text]
Time matters: A retrospective study of cancer care in a Brazilian public university hospital.
Authors: Souza Camila Brambilla , Neto José Tristão , Padua Tiago Costa de , Tadokoro Hakaru , Almeida Michelle , Ribas Christian
Published: May 2019

e18171

Background: The perception of symptoms, diagnosys, access to a cancer care institute and the first-line of therapy are milestones of cancer care. The success of an oncological treatment is directly relatable to these key-points and the time gaps between them. Growing research in developing countries points out the challenges of offering quality of care in this setting as social, cultural, economic and political factors are deeply intertwined. The objective of this study is to identify the key-points of cancer care, the time gaps between them and the time-related end-points of patients refered to a medical oncology department of a public university hospital in São Paulo, Brazil, in the period of one year. Methods: This is a observational retrospective study based on review of medical records of all cancer patients refered to the medical oncology department of a public university hospital in São Paulo, Brazil, from 01/01/17 to 12/31/17. The analysis was performed in January 2019. The data collected comprises the age at diagnosys, gender, primary tumor site, stage (AJCC 7th ed. staging system), onset of symptons, date of hystopathological diagnosys, the first therapeutic modality and when it was offered, intention of care (curative or palliative), outcomes and the following time-relations: symptoms-dyagnosis (SD), dyagnosis-treatment (DT) and symptoms-treatment (ST). Results: From 358 profiles, 275 were included. The average age at diagnosys was 58,7 years (15-88 years). Men were 147 (53,4%) and 128 (46,5%) were women. The most common primary tumor sites were gastrointestinal tract 22,9%, head and neck 20,3%, cutaneous melanoma 17,8% and genitourinary tract 16%. 160 (58,1%) patients were diagnosed at advanced/metastatic stages (III/IV). The median time-relations were: 5,5 months for SD; 2 months for DT and 8 months for ST. The first treatment offered was surgery at 63,2% of cases, radiotherapy 17,8%, systemic therapy 16,7% (endocrine therapy, targeted therapy or chemotherapy) or palliative care 1,8%. The intention of the initial treatment: 76,3% were curative and 23,2% palliative. At time of analysis, 63,6% of patients were alive, 19,2% deceased and 16,7% of unknown outcome. Conclusions: Our data endorses prevalent findings of developing countries epidemiological studies: late diagnosys, non-curative treatments and poor outcomes. Known causes are desfavorable social-economic conditions, symptom neglection, ineffective cancer screening and deficiency of public cancer care networks. We emphasize time goals as important quality indexes to guide new solutions.
Evaluation of selective outcome reporting bias in efficacy endpoints in print and television advertisements for oncology drugs.
Authors: Wayant Cole , Aran Greg , Vassar Matt
Published: May 2019

e18179

Background: Drug advertisements marketed to consumers and healthcare providers have been the subject of recent debate, and the efficacy endpoints that underpin these advertisements may sway perceptions of drug efficacy. Methods: Using the AdPharm database we extracted data for oncology drug advertisements printed or aired between March 1, 2017 and September 1, 2018. Our primary objective was to evaluate endpoints from television and print advertisements and endpoints from the corresponding published papers. A secondary objective is to identify the frequency of drug advertisements that are aired or printed while overall survival data is immature. Results: We included 74 advertisements for 34 unique oncology drugs and 22 unique indications. Print ads were most common (n = 66) and most print ads were targeted to healthcare providers (n = 55, 83.3%). The 74 advertisements were underpinned by 48 published clinical trials. The primary endpoint of the 48 underpinning trials was most often PFS (n = 25), followed by OS (n = 11) and ORR (n = 7). Primary endpoints of underpinning trials were not reported in 8 (8/74, 10.8%) advertisements. Statistically significant endpoints were reported more often than nonsignificant endpoints (RR 1.42; 95% CI, 1.26 - 1.60). Thirty advertisements (42.3%) ran while OS data was immature. When OS and PFS were statistically significant, they were reported at a significantly higher rate than when not reported (each P < .001). ORR was not preferentially reported based on its statistical significance (RR 1.33; 95% CI, .94 - 1.87). Conclusions: Oncology drug advertisements appear to preferentially report statistically significant endpoints, which is highly suggestive of selective outcome reporting bias. By reporting only endpoints that achieve statistical significance, advertisers may encourage misconceived notions about a drug’s efficacy profile.
A nationwide study for patterns of immune thrombocytopenia treatment in patients with chronic lymphocytic leukemia.
Authors: Atallah-Yunes Suheil Albert , Haddadin Faris , Kadado Anis , Clark Jackson , Ready Audrey Anne , Ali Syed S.
Published: May 2019

e18193

Background: Steroids and Intravenous immunoglobulin (IVIG) are considered as the first line of therapy in immune thrombocytopenia (ITP) when treatment is indicated. Approximately 5% of patients with untreated CLL and 25-30% of patients with previously treated CLL have thrombocytopenia. There is limited data about ITP treatment patterns and therapeutic responses in patients with CLL. Methods: This is a retrospective cohort study using the 2016 National Inpatient Sample of adults ( > 18 years) hospitalized for ITP as the admitting diagnosis and CLL as a secondary diagnosis based on ICD-10 codes. Primary outcomes were rate of administration of IVIG, splenectomy, platelet transfusion and packed red blood cell transfusion during same admission. Length of hospitalization was a secondary outcome. Multivariate linear regression was used to adjust for cofounders of age, gender, race and Charlson comorbidity Index. STATA 15 was used for analysis. Results: 14,490 patients were admitted for ITP (56% females, mean age 46), of which 255 had CLL (95 females, mean age was 72.4). On multivariate linear regression there was a significant increase in the use of IVIG among ITP patients with CLL (OR: 2.11; 95%-CI 1.05-4.23, P = 0.03). While there was no difference in terms of splenectomy rate ( OR: 0.35, 95% CI 0.05 to 2.52, p = 0.28 ) or rate of platelet transfusion (Odds ratio 1.15, 95% CI 0.63 to 2.08, p = 0.65) and packed red blood cell transfusion (Odds ratio 1.03, 95% CI 0.44 to 2.39, p = 0.94) between patients who have ITP with CLL and patients admitted with ITP without CLL. No statistical difference was found in hospitalization length. Conclusions: Patients hospitalized for ITP with CLL were more likely to require IVIGs. This could be explained by several theories including the need for a more rapid increase in platelet count as thrombocytopenia may be more severe due to bone marrow infiltration by CLL, immune dysfunction and/or treatment induced thrombocytopenia. Additionally, CLL patients can have hypogammaglobinemia making them more likely to get IVIG as a treatment of choice for ITP and as an immune replacement. Also ITP patients with CLL may have less response to steroids, as was noted in a previous study. Fear of atypical infections due to steroids in CLL patients may result in increased IVIG use. Further research of the microenvironment of ITP in CLL patients might explain the difference in treatment pattern and therapeutic response in this population.
Re-evaluating the neutrophil-to-lymphocyte ratio: Machine learning-based variable selection for predicting survival at twelve months in late-stage cancer patients receiving immunotherapy.
Authors: Spakowicz Daniel , Li Mingjia , Hoyd Rebecca , Burkart Jarred Thomas , Patel Sandip H. , Husain Marium , He Kai , Presley Carolyn J , Bertino Erin Marie , Shields Peter G. , Carbone David Paul , Shah Hiral A. , Tinoco Gabriel , Folefac Edmund , Bhateja Priyanka , Verschraegen Claire F. , Otterson Gregory Alan , Li Lang , Kendra Kari Lynn , Owen Dwight Hall
Published: May 2019

e18201

Background: Neutrophil to Lymphocyte Ratio (NLR) is prognostic for cancer patients treated with immune checkpoint inhibitors (ICI). We showed the change in NLR early during treatment to be a stronger, curvilinear predictor, i.e. patients with an intermediate change in NLR performed better than those with large decreases or increases. This led us to re-examine whether NLR is an optimal predictor of overall survival (OS). Methods: A retrospective review of 467 patients with advanced cancer who received ICIs from 2011 to 2017 at the Ohio State University was performed with IRB approval. NLR was collected at the initiation of ICI and on-treatment (median 21, IQR 8 days) and calculated as ratio of absolute neutrophil to lymphocyte counts. Variable selection machine-learning algorithms included fast and frugal decision trees and random forest, performed in R. Results: The machine-learning algorithm fast and frugal decision trees identified the ratio of NLR on treatment to baseline NLR, the NLR on treatment, the change in NLR and the cubic change in NLR to be the most informative predictors of survival at 12 months. A random forest algorithm identified the same four variables as the most important for prediction accuracy. Age, sex and cancer type were the least informative predictors in the model, suggesting the on-treatment NLR variables are of value across wide range of demographics. Conclusions: NLR measured during treatment, and its derivative values of the ratio to baseline, change from baseline, and the cubic change from baseline, hold more predictive value than NLR measured at baseline. Common control variables such as age, and sex showed little effect on the model, suggesting on-treatment NLR is useful across wide demographic space. [Table: see text]