bluuebunny/crossref_metadata_2025 huggingface dataset:
Survival disparities in top five cancers in the United States: A population based study.
Authors: Nutalapati Snigdha , Chen Quan , Huang Bin , Myint Zin
Published: June 2021

e18545

Background: Health inequity is an important field in cancer research and it is vital to determine the underlying etiologies to eliminate health disparities. Health insurance differences in survival outcomes have been reported for patients residing in California and New Jersey. Likewise, we aim to explore the impact of variations in insurance status and demographic factors on survival outcomes in patients with the top five cancers in the United States using a nationwide cancer registry. Methods: Surveillance, Epidemiology, and End Results (SEER) 18 program was queried to identify patients with a primary diagnosis of lung, breast, colorectal, prostate cancer, and melanoma from 2007 to 2016. Patient characteristics included are age (≥20 years), sex, marital status, metropolitan or non- metropolitan residence, insurance status (private vs. Medicaid vs. uninsured), education level, stage at diagnosis, and survivals. Descriptive and survival analyses were performed using Pearson Chi-square, Kaplan-Meier and Cox regression tests. Results: A total of 935,916 patients were included, of which 344,022 (37%) had breast cancer, 209,762 (22%) prostate cancer, 151,553 (16%) colorectal cancer, 151,468 (16%) lung cancer, and 79,111 (8%) melanoma. Most patients were aged > 50 years (76%) and 55% were female. Privately insured accounted for 83% of all patients, 13% had Medicaid and 4% were uninsured. Male gender, married, patients with higher education level, residing in metropolitan areas were more likely to have private insurance (p < 0.001) compared to female gender (84.3% vs. 81.2%), unmarried (90.1% vs. 68.7%), subjects with very low to moderate education level (88.2% vs. 80.8%), and ones residing in non- metropolitan areas (83.4% vs. 76.3%). Patients with private insurance were more likely to be diagnosed at localized stage compared to Medicaid insured and uninsured (59.2% vs. 38.2% and 36.6%; p < 0.001). On bivariate and multivariate analyses across of all five cancers, age > 50 years (HR 2.0; p < 0.001), male gender (HR 1.3; p < 0.001), single (HR 1.3; p < 0.001), Medicaid insurance (HR 1.2; p < 0.001), and uninsured (HR 1.3; p < 0.001) were associated with worse overall survival than age < 50 years, female, unmarried, and privately insured. Conclusions: Along with noticeable survival disparities by insurance status in lung, breast, colorectal, prostate and melanoma, we noted that privately insured patients are more likely to be presented at an earlier stage compared to patients with Medicaid and uninsured. Additionally, elderly age, lower education level, unmarried and low socioeconomic status had a negative impact on survival. Multidisciplinary care team efforts are critical in mitigating these health disparities.
Satisfaction with care and attention to salient concerns by race in a diverse national sample of young women with breast cancer.
Authors: Carroll Bridget Rose , Zheng Yue , Ruddy Kathryn Jean , Emmons Karen , Partridge Ann H. , Rosenberg Shoshana M.
Published: June 2021

e18561

Background: Young women with breast cancer (BC) have unique issues, including fertility, genetic, and emotional health concerns; these may sometimes be inadequately addressed by providers. Given documented disparities in BC care and outcomes, we sought to explore whether provider attention to these issues differs by race, as well as to examine racial differences in satisfaction with care among young patients with BC. Methods: The Young & Strong Study was a cluster randomized trial of an educational and supportive care intervention at 14 academic + 40 community oncology practices across the US enrolling women with newly diagnosed BC at age ≤45 and their providers. Patients completed surveys at baseline, 3, 6, and 12 months after enrollment. Race was self-reported at baseline. Provider attention to fertility, genetics, and emotional health was evaluated by medical record review. The proportions of patients with attention to these concerns by 3 months was compared by race (white, Black, Asian, multi-racial/other/unknown) using Fisher’s exact tests. Satisfaction with care was assessed with the Patient Satisfaction Questionnaire-18 (PSQ-18) at 3 months. Median scores for each of 7 PSQ-18 subscales (1-5 scale, higher scores=more satisfaction) were compared by race with the Kruskal-Wallis test. Results: 465/467 (99.6%) of enrolled patients had evaluable data. 77% were white, 12% Black, 4% Asian, and 7% multiracial/other/unk. Median age at diagnosis was 40 (range: 22-45) years. Provider attention to genetics (≥85%) and emotional health (≥90%) was high across groups, and there were no differences by race in attention to fertility, genetics, or emotional health (Table). Among 359/465 women (77%) who completed the PSQ-18, median subscale scores ranged from 3.5-4.5, indicating high levels of satisfaction with care. For the PSQ-18 technical quality domain, median scores were lower (p=.03), indicating less satisfaction, in Black and Asian women (4.0) and higher in white women (4.5). Median scores for other PSQ-18 domains (general satisfaction, interpersonal manner, communication, financial, time spent with doctor, accessibility) did not differ by race. Conclusions: Satisfaction with care was high and issues related to fertility, genetics and emotional health were addressed by providers in the majority of young women in our study, with minimal differences by race. These patients were all enrolled in a clinical trial and had access to high-quality care, limiting the generalizability of our findings. Larger, population-based studies in more diverse settings are warranted. Clinical trial information: NCT01647607.

Attention to psychosocial concerns by race.

[Table: see text]
Phase III randomized clinical trials global distribution and funding: Trends and disparities.
Authors: Pinheiro Karina , Ribeiro Mauricio , Gadotti Luiza Lara , Marson Fabiane , Lopes Carlos Diego Holanda , Saddi Rodrigo , Alessi Joao Victor Machado , Katz Artur
Published: June 2021

e18563

Background: Phase III clinical trials (PIIICT) constitute the cornerstone of the progress and development of new therapeutic strategies. However, their complexity and costs in a scenario of limited funding sources impose important limitations in their scope and reach. Methods: We searched in clinicaltrials.gov to identify PIIICT evaluating pharmacological interventions in adjuvant, neoadjuvant and metastatic settings between 2010-2020 in breast, cervix, colorectal cancer (CRC), lung, melanoma, prostate and penile cancer. Trials identified were categorized according to disease site, funding source and world region/country (R/C). Case incidence in 2020 was collected from the IARC website. Results: Of 825 clinical trials, 72.7% were industry-sponsored (IS). Trials by R/C, not including multicentric studies (61.8%): (A) USA 76 trials, 53.9% non-industry sponsored (NIS); (B) Europe/UK 112, 59.8% NIS; (C) Asia (excluding China) 62, 27.4% NIS and (D) China 183, 43.7% NIS. There was a statistically significant association between location and funding source (p= 0.0003). NIS source was detected in higher proportion of trials ongoing in regions A and B (59%). IS was statistically less frequent in uterine cervix/penis (42.8%) and CRC (49.6%) IS was significantly higher in lung and prostate trials (both 81%) (p<0.0001). Table summarizes our results by tumor sites. We also found a statistically significant association between the incidence of malignancies in the selected primary sites and the amount of registered clinical trials, overall (p<0.0001) and IS as well (p<0.0001). The database is under expansion to include other disease sites as well as other geographic areas separately (Africa, Russia, South America, India, and Oceania). Cervix and penile results were combined given their biological and epidemiological similarities. Conclusions: There is a significant disparity between the number of clinical trials and tumor prevalences as well as among the distribution of IS trials funding.[Table: see text]
Cancer care during COVID-19: Data from 157 patient organizations.
Authors: Warwick Lorna , Baugh Elisabeth , Cardoso Fatima , Giles Rachel H. , Filicevas Alex , Fox Jesme , Oliver Kathy Rose , Reid Frances , Isaacson Jenny , Spiegel Andrew , Ventura Roberta , Sheahan Nicole , MacKay Clara
Published: June 2021

e18564

Background: Representatives from 8 global cancer coalitions/alliances, representing 650 cancer patient groups and the interests of over 14 million patients have come together during the pandemic to review and evaluate the patient-perspective impact. Cancer services have faced challenges as a result of COVID-19, including suspension of screening and diagnostic services; delays in diagnosis leading to higher mortality rates; cancellation/deferral of life-saving treatments; changes in treatment regimens and suspension of vital research. For organisations that provide support to cancer patients, declining income, the need to reduce staff and move to virtual working practices has put extra strain while demand for support due to the pandemic has increased. Methods: 5 coalitions surveyed their member organisations. A number of coalitions consulted their members by individual surveys or consultations. Results: A survey of 157 organisations representing advanced breast, bladder, lymphoma, ovarian and pancreatic cancer patient groups from 56 countries found that 57% experienced an average increase of 44% in patient calls and emails. 45% reported that their future viability may be under threat because of the impact of COVID-19 on income. Examples of good practice were reported where healthcare systems have acted to protect patients and cancer services. These include the introduction of COVID-free centres, separation of cancer patients from those who may have COVID-19, and the introduction of virtual and telemedicine services. Organisations have also introduced new ways of working including virtual psychological support services and app-based support groups. These best practices should form part of a global plan of action for future health crisis. Conclusions: Collaboration between patient advocacy organisations, governments and health services is needed to ensure the ground lost to the COVID-19 pandemic is regained. Action is required to restore cancer services safely and effectively without delay. Additional resources for organisations that support cancer patients are required to ensure that they continue to provide vital services. Finally, a global plan of action for cancer is required to meet the challenges of any future health crisis.
Impact of Medicaid expansion on pancreatic cancer care: A difference-in-difference analysis.
Authors: Hamad Ahmad , Eskander Mariam , Li Yaming , Bhattacharyya Oindrila , Fisher James L , Oppong Bridget A. , Obeng-Gyasi Samilia , Tsung Allan
Published: June 2021

e18567

Background: The Affordable Care Act (ACA) increased insurance coverage for low-income individuals, which should potentially lead to better access to care and improved oncological outcomes. This study seeks to evaluate the impact of Medicaid expansion (ME) on care for pancreatic ductal adenocarcinoma (PDAC). Methods: Patients who were uninsured or on Medicaid and diagnosed with PDAC between 2004 and 2017 were queried from the National Cancer Database (NCDB). Two different expansion cohorts were included: early expansion states and 2014 expansion states. For early expansion states, the time period of pre-expansion was 2004-2009 and post-expansion was 2010-2017. As for the 2014 expansion states, the pre-expansion period was from 2004-2013 and post-expansion period was from 2014-2017. Patients in non-expansion states formed the control group. A difference-in-difference (DID) analysis was used to assess the association of ME with stage of diagnosis, treatment and survival for each expansion cohort. Results: In both early and January 2014 expansion states, there was an increase in overall Medicaid coverage (Early: DID = 0.29, 2014: DID = 0.37; P < 0.001), in particular for non-Hispanic Black and Hispanic Black patients (Non-Hispanic Black: Early: DID = 0.11, 2014: DID = 0.11; P < 0.001, Hispanic-Black: 2014: DID = 0.20; P = 0.003). There were no differences in early stage diagnosis (Early: DID = 0.02, 2014: DID = -0.02; P > 0.05). There was an increase in the number of patients receiving surgery (Early: DID = 0.05; P = 0.001, 2014: DID = 0.03; P = 0.029) but no difference in time to surgery among patients receiving surgery upfront (Early: DID = 1.75, 2014: DID = 0.38; P > 0.05). There was no difference in 30-day readmission post-surgery (Early: DID = 0.003; 2014: DID = -0.00007; P > 0.05) or 90-day mortality (Early: DID = -0.007, 2014: DID = -0.035; P > 0.05). Moreover, there was no difference in receipt of chemotherapy (Early: DID = 0.01, 2014: DID = 0.005; P > 0.05) or time to chemotherapy for patients receiving neoadjuvant chemotherapy (Early: Early: DID = 9.62, 2014: DID = 0.01; P > 0.05). Finally, there was no difference in receipt of palliative care among stage IV patients in both cohorts (Early: DID = -0.004, 2014: DID = 0.004; P > 0.05). Conclusions: This study suggests that after ME, PDAC patients were more likely to be insured and had increased access to surgical care. Future, studies should evaluate the implications of improved surgical access on clinical outcomes such as mortality.
Racial/ethnic differences in knowledge and attitudes towards clinical trials among adults in the United States: An analysis of the 2020 U.S. HINTS.
Authors: Islam Jessica Yasmine , Vidot Denise Christina , Islam Imran K , Rivera Argelis , Camacho-Rivera Marlene
Published: June 2021

e18573

Background: Despite the use of clinical trials to provide gold-standard evidence of treatment and intervention effectiveness, racial/ethnic minorities are frequently underrepresented participants. Our objective was to evaluate racial/ethnic differences in knowledge and attitudes towards clinical trials among adults in the U.S. Methods: We leveraged Health Informational National Trends Survey (HINTS) data, which is a weighted, nationally representative survey of 3865 adults (≥18 years). Data were collected between February-June 2020, and included age, race/ethnicity, sex, cancer history, and comorbidities. Participants were asked questions focused on clinical trials, including their knowledge, influential factors to participate, trusted sources of information, and if they were ever invited or participated in a clinical trial. Among adults who self-reported to have heard of clinical trials (n = 2366), we used multivariable logistic regression to evaluate racial/ethnic differences in self-reported invitation and participation in clinical trials after adjustment for cancer history, age, sex, comorbidities, and insurance status. Results: Overall, the sample included 64% non-Hispanic (NH) White, 11% NH-Black, 17% Hispanic, and 5% NH-Asian respondents. Nine percent were cancer survivors. Almost 60% self-reported to at least have some knowledge about clinical trials. When asked about factors that would influence their decision to participate in clinical trials “A lot”, participants across racial groups most frequently chose “I would want to get better” and “If the standard care was not covered by my insurance.” Cancer survivors also frequently reported their decision would be influenced “A lot” or “Somewhat” if “My doctor encouraged me to participate.” NH-White (76%), NH-Black (78%), and Hispanic (77%) cancer survivors reported their trusted source of information about clinical trials was their health care provider; NH-Asian cancer survivors reported their health care provider (51%) as well as government health agencies (30%). Compared to NH-White adults, NH-Black adults were more likely to be invited to participate in a clinical trial (OR: 2.60, 95% CI: 1.53-4.43). However, compared to NH-White adults, our data suggest NH-Black adults were less likely to participate in the clinical trial (OR: 0.76, 95% CI: 0.39-1.49) although not statistically significant. Compared to NH-White adults, NH-Asian adults were less likely to participate in clinical trials (OR: 0.10, 95% CI: 0.06-0.18). Conclusions: Health care providers are a trusted source of clinical trial information. Although NH-Black adults are more likely to be invited, they are less likely to participate in a clinical trial; as well as Asian adults. Efforts to leverage insights gained on factors of influence and sources of trusted information on clinical trials should be prioritized.
Differences in clinicopathological characteristics, treatment, and survival outcomes between older and younger breast cancer patients: A regional perspective.
Authors: Abdel-Razeq Hikmat , Iweir Sereen , Abdel-Razeq Rashid , Abdel Rahman Fadwa , Almasri Hanan , Bater Rayan , Taqash Ayat
Published: June 2021

e18604

Background: In developing countries, breast cancer treatment outcomes may be uniquely affected by the tendency of breast cancer patients to develop the disease at a much younger age than the worldwide average. Contrarily, older patients tend to present with multiple comorbidities that complicate their outcomes and influence their treatment options and decisions. This study will be the first to investigate the dichotomies between older and young breast cancer patients in our region. Methods: The study was based on data collected from the cancer registry of our institution for breast cancer patients 65 years or older (n = 553), and patients 40 years or younger (n = 417) at time of diagnosis. Statistical models were used to investigate the associations between age groups, clinical characteristics and treatment outcomes. Results: A total of 970 patients were included in the final analysis. Compared to younger patients, older ones were more frequently diagnosed with distal metastasis; 20.6% compared to 15.1%, p =0.028. However, among patients with non-metastatic disease, younger ones tended to have more aggressive pathological features, including positive axillary lymph nodes (73.2% vs. 55.6%, p< 0.001), T-3/4 (28.2% vs. 13.8%, p< 0.001) and HER2-positive disease (29.3% vs. 16.3%, p< 0.001). A higher percentage of patients from the young cohort underwent surgery (85.4%) when compared to the older group (74.9%), p< 0.001. More patients in the older group had mastectomy than did younger patients (67.5% versus 40.2%, p< 0.001), while breast conserving surgery (BCS) was performed on almost a third in each cohort, p= 0.245. Skin-sparing, with or without, nipple-sparing mastectomies (SSMs) along with breast reconstruction surgery were more frequently performed on younger patients than they were on the older patients. After a median follow-up of 59 months for the younger patients and 45 months for the older ones, the 5-year OS rate of the older patients was 67.6% compared to 72.1% for the younger patients, p= 0.035. However, the 5-year DFS rates of the two cohorts were not statistically different at 63.9% for the older group and 60.7% for the young patients, p= 0.31. The survival of patients with non-metastatic disease was also compared among both groups; the 5-year OS among the younger patients was significantly higher (83.6% compared to 78.8% among the older patients, p= 0.046). Survival was better among the younger patients across many clinical and pathological characteristics. Conclusions: Younger patients with breast cancer present with worse clinical and pathological features, albeit a better OS rate. The difference in DFS between the two groups was insignificant, suggesting that older women were more likely to die from non-cancer related causes.
Health-related quality of life in the treatment and survivorship phases of breast cancer.
Authors: Kaur Manraj , Klassen Anne , Xie Feng , Rae Charlene , Pusic Andrea
Published: June 2021

e18621

Background: Understanding the health-related quality of life (HRQOL) of breast cancer during treatment and survivorship is important; however, little data are available - particularly for long-term ( > 5 year) survivors. Health utility scores anchored between 0 (death) and 1 (perfect/best possible health) have been shown to be a good proxy index score of the overall HRQOL. The aim of this study was to estimate the utilities in the treatment and survivorship of breast cancer using validated preference-based measures(PBMs). Methods: Women (18 years or older) with history of breast cancer (on/off treatment) were recruited via Love Research Army (LRA), an online community of women engaged in breast cancer research. Members of the LRA were invited to participate via email and women who self-selected to be eligible were asked to complete clinical and demographics form and two generic PBMs - EQ-5D and Short Form-12 (SF-12), and one cancer-specific PBM-European Organization for Research and Treatment of Cancer-8D (EORTC-8D). Descriptive statistics and non-parametric analysis of variance tests were used to examine differences between the survivorship groups. Results: 1,636 women aged 46 ± 10 years were included in the analysis. Mean age at primary diagnosis was 35 ± 10 years and most patients were diagnosed with breast cancer stage 0-2 (n = 1362, 83.25%). For women currently on treatments, mean utility values were: chemotherapy (EQ-5D = 0.61, SF-6D = 0.67,EORTC-8D = 0.69), radiation(EQ-5D = 0.71, SF-6D = 0.67, EORTC-8D = 0.66), hormone replacement therapy (EQ-5D = 0.82,SF-6D = 0.76,EORTC-8D = 0.85), targeted therapy (EQ-5D = 0.77, SF-6D = 0.74, EORTC-8D = 0.82), and surgery (EQ-5D = 0.81,SF-6D = 0.69, EORTC-8D = 0.78). For women diagnosed with arm lymphedema (n = 182,11%), utility values were EQ-5D = 0.79,SF-6D = 0.74, EORTC-8D = 0.82. Women who were ≤ 5 years post-primary diagnosis reported slightly lower utility values (EQ-5D = 0.82,SF-6D = 0.76,EORTC-8D = 0.84) than women who were 6-10 years (EQ-5D = 0.83,SF-6D = 0.76,EORTC-8D = 0.85; p = 0.117) post-primary diagnosis. However, when utilities for women who were ≤ 5 years post-primary diagnosis were compared to women who were 11 to 15 years (EQ-5D = 0.86,SF-6D = 0.79,EORTC-8D = 0.88) and over 15 years (EQ-5D = 0.86,SF-6D = 0.81,EORTC-8D = 0.89) post-primary diagnosis, the difference was statistically significant (p = 0.000). Women who belonged to non-White ethnic groups, had lower levels of education (Bachelors or less) and reported less than USD 50,000 annual income in the previous year reported lower utility values across all time points, after adjusting for age and cancer stage. Conclusions: This study shows that the HRQOL decline in the first five years post-primary breast cancer diagnosis persists for several years into survivorship. Further, women from ethnic minority groups and lower socioeconomic background have lower HRQOL, irrespective of their age and cancer stage.
Association of HIV infection with survival and cancer-specific death in cancer patients in Louisiana.
Authors: Subbiah Suki , Meckstroth Shelby , Yi Yong , Maniscalco Lauren , Wu Xiao-Cheng , Plaisance-Bonstaff Karlie , Parsons Christopher
Published: June 2021

e18630

Background: Studies have reported elevated mortality in HIV patients (pts), including cancer-specific mortality, compared to non-HIV pts. However, many of these studies did not include data from Louisiana. Louisiana has among the highest HIV and AIDS case rates in the country, but there is no available large-scale data regarding cancer outcomes in HIV pts in the state. We compared our data in Louisiana to the largest known study to date over an expanded time period to evaluate for disparities. Methods: Following linkage of Louisiana Tumor Registry data from 1995-2016 and Louisiana Office of Public Health, STD/HIV Program database, we identified a total of 435,478 cancer cases, of which 2,949 were HIV-positive (0.67%). Analyses of categorical variables were performed using Pearson’s chi-squared test. Cause of death was extracted from death certificate or autopsy report. Survival analyses were performed utilizing SEER*Stat. Results: Despite the higher proportion of HIV in cancer pts in Louisiana, demographics are similar to previously published data in that cancer pts with HIV tended to be male, black, and younger than their HIV-negative counterparts (p<0.001). However, although 5-year survival was substantially decreased in HIV-cancer pts in congruence with other studies, cancer-specific mortality was lower than non-HIV pts in all cohorts, including both AIDS-defining cancers (ADC) and non-AIDS-defining cancers (non-ADC). Conclusions: HIV infection in cancer pts in Louisiana is associated with lower survival but not increased cancer-specific death, independent of race, gender, age, ADC vs non-ADC, and viral vs non-viral etiology. HIV-related deaths still comprise a substantial cause of death in this population.[Table: see text]
Outcomes and applicability of a deep learning virtual tumor board (DLVTB) in community-dwelling colorectal cancer (CRC) patients.
Authors: Desai Aakash , Loaiza-Bonilla Arturo , Culcuoglu Cagatay , Johnston Kristin , Kurnaz Selin
Published: June 2021

e18635

Background: With almost 85% of patients treated outside NCI-designated cancer centers, providing comprehensive, state-of-the-art cancer care to millions of patients in the U.S. remains a significant challenge. We aimed to combine cutting edge AI based technology of DLVTB with high value-added services to provide evidence-based care management recommendations and implementation support to the patients and physicians in the community. To further demonstrate the feasibility, reproducibility, scalability, and benefits of DLVTB, we evaluated key outcomes from incorporating DLVTB in a cohort of 35 patients with advanced colorectal adenocarcinoma (CRC). Methods: Our core-enabling technology is a deep learning based Natural Language Understanding Engine that employs (1) natural language processing for medical text digestion and structuring, (2) decision trees and multilayer perception models to produce evidence-based treatment protocols, and (3) natural language based report generation. The technology platform is combined with human support from oncology sub-specialists to deliver a comprehensive Interpretive Report with a prioritized list of recommendations for each patient. These recommendations are operationalized by a case management team to ensure care implementation and monitoring of outcomes. Results: Thirty-five patients with CRC were referred for incorporation of DLVTB into clinical practice. Median age of patients was 57 years with 68.6% males. About 88.6% of the patients were Stage IV and 82.9% were treated by community practice oncologists. Median time since diagnosis was 17 months (1-73 months). Overall, DLVTB-cohort demonstrated an increase in median Overall Survival of 12 months per patient in comparison with historical cohorts. More specifically, DLVTB recommended initial and/or additional biomarker testing for 71% of the patients with further precision oncology-guided treatment recommendation (e.g. an EGFR inhibitor) for 80% of the patients. 63% of the patients were eligible for at least one clinical trial. 58% of the trials identified were within proximity (≤50 miles) of the patient’s primary residence. Thus, DLVTB was able to identify a trial that did not require extensive travel, provided eligibility and actionability closer to the point-of-care. 14% of the DLVTB evaluated patients subsequently enrolled in the recommended clinical trial, far surpassing the national average (3%). Moreover, DLVTB recommended treatments achieved on average savings of $39,194 per patient which is 35% of the average drug cost per patient. Conclusions: Our results demonstrate the feasibility and benefits of incorporating DLVTB into clinical practice. The utilization of DLVTB as a clinical trial enrollment tool and an engine for development of pathways resulting in improved clinical outcomes, in a cost-effective, and innovative care delivery model.
Hospital variation in cancer treatments and survival outcomes of advanced melanoma patients: Nationwide quality assurance in the Netherlands.
Authors: van Breeschoten Jesper , van den Eertwegh Alfonsus Johannes Maria , De Wreede Liesbeth , van Zwet Erik W. , Hilarius Doranne , Haanen John B. A. G. , Blank Christian U. , Aarts Maureen J.B. , Van Den Berkmortel Franchette , de Groot Jan Willem , Hospers Geke , Kapiteijn Ellen , Piersma Djura , Van Rijn Rozemarijn , Van Der Veldt Astrid Aplonia Maria , Vreugdenhil Gerard , Stevense Marion , Boers-Sonderen Marye , Suijkerbuijk Karijn , Wouters Michel W.J.M.
Published: June 2021

e18641

Background: The introduction of new systemic treatments for advanced melanoma has markedly changed the outcome of patients with metastatic melanoma. To assure high quality of care for patients treated in Dutch melanoma centers, hospital variation in treatment patterns and outcomes are evaluated in the Dutch Melanoma Treatment Registry. The aim of this study was to assess center variation in treatments and 2-year survival probabilities of patients diagnosed between 2013-2017 in the Netherlands. Methods: We selected patients diagnosed between 2013-2017 with unresectable stage IIIC or IV melanoma, registered in the Dutch Melanoma Treatment Registry. Centers’ performance on 2-year survival was compared by means of a multivariable Cox proportional hazards model with a random effect for center ID. Variation between centers was expressed by median hazard ratios. Therapy with BRAF/MEK inhibitors, anti-PD-1 antibodies or ipilimumab plus nivolumab was added to the Cox proportional hazards model as a time dependent covariate to assess the influence of new systemic therapies on center variation. Results: Between 2013-2017, 3820 patients were diagnosed with unresectable stage IIIC or IV melanoma. For patients diagnosed between 2013-2015, significant center variation in 2-year survival probabilities was observed. Median hazard ratio was 1.17 (95%CI: 1.09-1.31) for patients diagnosed between 2013-2015 after correcting for case-mix and treatment with BRAF/MEK inhibitors, anti-PD-1 antibodies or ipilimumab plus nivolumab. Use of new systemic therapies had a significant effect on up to 2-year survival (hazard ratio = 0.83, 95%CI (0.73-0.94)) with no use of the new systemic therapies as a reference. From 2016 onwards, no significant difference in 2-years survival was observed between centers. Conclusions: The different use of new cancer treatment of metastatic melanoma had an effect on survival outcomes in the Netherlands. A platform such as the Dutch Melanoma Treatment Registry, in which melanoma centers collaborate and have insight in variation in treatment patterns and outcomes between centers, results in fast implementation of new clinical developments across all Dutch melanoma centers.
An optimized mathematical model for cancer patient care planning in the COVID-19 era.
Authors: Blancas Isabel , Martínez-Rodríguez David , Rodríguez-Serrano Fernando , Villanueva Rafael Jacinto , Garrido Jose Manuel
Published: June 2021

e18663

Background: The COVID-19 pandemic has threatened to collapse hospital and Intensive Care Unit (ICU) services, and it seems to limit the care of oncologic patients. The objective was to develop a mathematical model designed to predict the hospitalization and ICU admission demands due to COVID-19 to forecast the availability of hospital resources for the scheduling of oncological surgery and medical treatment that require hospitalitation or possible use of ICU services. Methods: We have implemented a SEIR model designed to predict the number of patients requiring hospitalization and ICU admissions for COVID-19. We evaluated the model using the number of cases registered in the hospitals of the province of Granada (Spain), that altogether cover 914,678 inhabitants. Calibration was performed using data recorded between March 15 and September 22, 2020. After that, the model was validated by comparing the predictions with data registered between September 23 and November 7, 2020. Besides, we performed a predictive analysis of scenarios regarding different possible sanitary measures. Results: Using patient registered data we developed a mathematical model that reflects the flow among the different sub-groups related to COVID-19 pandemics (Table). The best algorithm that fitted the disease dynamics was Particle Swarm Optimization, that minimized the difference between model output and real data used to calibrate the model. The validation phase showed the accuracy of the predictions, especially concerning trends in hospitalizations and ICU admissions. The different scenarios modelled on November 10, 2020 allowed us to predict the evolution of the pandemic until July 1, 2021, and to detect the peaks and valleys of disease prevalence. Conclusions: The mathematical model presented provides predictions on the evolution of COVID-19, the prevalence and hospital or ICU care demands. The predictions can be used to detect periods of greater availability of hospital resources that make it possible to schedule the oncologic surgery and intensify the care for oncologic patients. Furthermore, our model can be adapted to other population by recalibrating the model according to demographic data, the local evolution of the pandemic and the health policies. [Table: see text]
Effect of activity monitoring on quality of life in patients with gastrointestinal cancer undergoing chemoradiation.
Authors: Kim Kristine N , Shah Nishant , Grewal Amardeep S. , Klinger Elissa , Ben-Josef Edgar , Plastaras John P , Metz James M. , Wojcieszynski Andrzej
Published: June 2021

e18671

Background: Patients undergoing concurrent radiation therapy and systemic therapy often experience significant toxicities, which can adversely affect their quality of life. We sought to determine if activity monitoring and early outpatient intervention could lead to improved quality of life (QoL) in patients with gastrointestinal malignancies undergoing chemoradiotherapy. Methods: In this prospective randomized trial, patients with gastrointestinal malignancies undergoing concurrent chemoradiotherapy were randomized to activity monitoring versus standard of care (observation). Each group was provided a commercially available fitness tracker but only the intervention group was actively monitored. If a patient in the intervention arm had a 20% decrease in step count or 20% increase in heart rate from their baseline, a triage visit was triggered to further evaluate and manage symptoms. In the observation group, step count and heart rate were recorded but no triage visit was triggered. All patients had weekly on treatment visits and access to standard communication methods for symptom management during and after-hour business hours. The primary endpoint was the rate of completed triage visits. QoL was a secondary endpoint and was collected from both arms at radiation simulation (baseline) and weekly during treatment using the EORTC QLQ-C30 (v.3). The mixed model for repeated measures was used for longitudinal analysis of global health status (GHS) and overall QoL scores (range 1-7) to determine the impact of intervention and time on QoL. Results: A total of 40 patients were evaluable in this study: 22 in the intervention group and 18 in the observation group. The primary endpoint was met with an increased rate of triage visits in the active monitoring group compared to the observation group (86.4% vs 39.9%, OR 9.95, 95% CI 2.12 -46.56, p = 0.015). EORTC QLQ-C30 questionnaires were completed by 97.5% of patients. The baseline QoL scores were similar in both arms (mean GHS 5.06 vs 5.50, p = 0.28 and mean QoL 4.98 vs 5.73, p = 0.09 in observation vs intervention group, respectively). There was a trend towards improved mean GHS, and QoL scores in the intervention group at all timepoints, although it did not reach statistical significance. Overall, GHS and QoL scores deteriorated from week 1 to week 6 during treatment in both groups (mean QoL 5.06 to 4.46, p = 0.16 in observation; mean QoL 5.55 to 5.03, p = 0.16 in intervention group). Conclusions: This study supports the feasibility of using activity monitor to actively track step count and heart rate to successfully trigger triage visits for patients at high risk for toxicity. Early outpatient intervention with the use of activity monitoring may improve quality of life in patients undergoing chemoradiotherapy.
Improving access to timely pain management in an underserved oncology clinic: A palliative care-oncology partnership.
Authors: Chan Aaron , Firtat Radu , Metchnikoff Christopher , Wu Phillis , Yu Katherine
Published: June 2021

e18672

Background: In the 4 years since inception, the palliative care (PC) clinic at Olive-View UCLA Medical Center (OVMC) cared for less than 6% of pain-positive cancer patients based on guidelines put forth by ASCO. As with other under-resourced safety-net settings, the demand for PC services at OVMC far exceeds the manpower available for optimal pain management in oncology patients. This year long project aims to improve pain management in a busy oncology clinic via enhanced identification and prompt treatment of cancer pain by Oncologists. Methods: At the project start, Oncologists were surveyed to identify key elements to be incorporated into formal didactics on pain management principles, case-based discussions and real-time mentoring. At the weekly oncology clinic, patients were screened for pain using the multi-modal PEG scale: Average Pain intensity (P), interference with Enjoyment of life (E), and interference with General activity (G) over the preceding week. The Oncologist was notified of the PEG score if a patient had an average score ≥4 (0-10 scale) for review and intervention. Patients were screened using the same method at subsequent visits. EHR of patients with PEG scores ≥4 were reviewed to determine whether therapeutic interventions were made by the Oncologist. A comparison of PEG scores to the standard nursing intake pain scores was also conducted. Results: Over a 4-month period, 513 PEG forms were administered, 37% of which resulted in a pain score ≥4. Of the 172 patients who screened positive, 54 patients were screened at follow up visit(s). Comparing the pain-positive cohort, we observed an average decrease in pain by 25.5% (7.1 to 5.3) in patients who received intervention as opposed to 7.4% (5.0 to 4.7) in patients who did not receive intervention by their Oncologist. Further, there was a remarkable divergence between the average PEG score (6.7) and nurse intake pain score (1.4) in this patient cohort. Conclusions: Our findings suggest that improved Oncologist real-time pain assessment and intervention incorporating a validated pain screening tool leads to timely pain management in cancer patients. Implementation of a Palliative Care-Oncology partnership promotes provider awareness and confidence in treating patients with complex pain. A functional pain assessment, using PEG, can more accurately reflect pain compared to the current standard nursing intake process. Particularly in resource challenged settings where access to PC is limited, facilitating timely pain management through training and mentoring of oncologists or other primary providers can be a sustainable model to improve patient access to primary palliative care. Given the early indicators of success we hope to expand this workflow in training other healthcare providers within our County safety net system. Research Sponsor: California Health Care Foundation.
Early impact of lung cancer screening program.
Authors: Emmerick Isabel M. , Lou Feiran , Powers Maggie M. , Guiab Keren , Bludevich Bryce , Lin Poliana , Maxfield Mark , Uy Karl
Published: June 2021

e18677

Background: Lung cancer has the highest mortality among the leading cancers in the U.S. Its detection in the early stages is one of the strategies to increase survival. This study aims to identify whether the implementation of a structured Lung Cancer Screening Program impacted the percentage of Early Stage Lung Cancer Diagnosis (ESLCD). Methods: Retrospective cohort study aiming to identify changes over time considering the following indicators: a) percentage of ESLCD; b) the percentage of lung resections for ESLCD. In October 2019, there was a restructuring of our institutional Lung Cancer Screening Program (LCSP). We analyzed quarterly incident lung cancer cases at our institution between October 2017 and December 2019. Descriptive, bivariate, and multivariate analyses were performed. Results: Our cohort comprised 736 patients. The age average was 69.3 years, 54.6% female, 96.5% white. Clinical Stage 1A to 2B corresponded to 43.3% of patients. 71.9% had their diagnosis and treatment in the institution. Factors associated with ESLCD were being in the LCSP (OR 4.4 [95%CI 2.3-8.1]); diagnosis and treatment in the institution (OR 2.2 [95%CI 1.6-3.2]); having 3 or less comorbidities (OR 1.6 [95%CI 1.2-2.1]) and female (OR 1.4 [95%CI 1.1-1.9]). In the last Quarter of 2017, the percentage of ESLCD through LCSP was 2.6%, and in the last Quarter of 2019 (2019Q4), 28.8%, representing a 1025% growth. Also, in 2019Q4, 44.8 % of the ESLCD cases that had surgery came through the LCSP, which is a significant increase from prior quarters. Conclusions: The restructuring of our LCSP may have resulted in an increase in ESLCD and the number of curative surgeries for Lung Cancer. Identification of opportunities for improvement of health care delivery can help to increase ESLCD; a longer time for follow-up is needed to observe if the upward trend is sustained and its effects on patient survival. Selected indicators by quarter, 2017 to 2019.[Table: see text]
Real-world treatment patterns among advanced HR+/HER2- breast cancer patients in the post-CDK4/6 inhibitor era: An analysis of administrative claims data.
Authors: Boyle Tirza Areli Calderón , Shukla Soham , Powers Happ Lindsey , Zheng Shan , Gorsh Boris
Published: June 2021

e18695

Background: The treatment paradigm for advanced HR+/HER2- breast cancer has been rapidly evolving since the approval of the first CDK4/6 inhibitor in the U.S. in 2015. Available literature on real-world utilization of various treatment options available to these patients remains limited. The objective of this study was to describe how advanced HR+/HER2- breast cancer treatment patterns have changed over time since the approval of novel CDK4/6 inhibitors. Methods: IBM MarketScan Research Databases, a nationally representative source of U.S. insurance claims data, was used to identify women diagnosed with advanced breast cancer between January 2015 and December 2019 via ICD-9/10 codes. Algorithms were applied to capture patients with HR+/HER2- subtype and advanced disease diagnosis. Patients were indexed on their advanced breast cancer diagnosis date and were required to have six months continuous enrollment in the insurance claims database prior to and after the index date to ensure patients included in the cohort were alive and contributed at least 12 months of data for analysis. Lines of therapy (LOTs) were constructed and treatment patterns were reported over time. Descriptive analyses were conducted using Instant Health Data software. Results: A total of 4,128 women (mean age: 58 years, IQR: 50-64 years) had received at least one systemic breast cancer treatment and were included in the analysis. During a mean follow-up time of two years, nearly 29% of patients received at least four LOTs for advanced disease. A high number of unique regimens were reported in each LOT (30 in 1L, 48 in 2L, 53 in 3L and 50 in 4L+). The distribution of the top 1L regimens changed significantly over time (Table). CDK4/6 inhibitor use in the 2L setting also increased substantially from 43% in 2015 to 68% in early 2019, while chemotherapy and endocrine monotherapy utilization decreased. Conclusions: These data reflect a significant shift in the treatment landscape for HR+/HER2- advanced breast cancer patients in real-world practice since the availability of CDK4/6 inhibitors. However, there remains significant heterogeneity in the use of other treatments in these patients and in treatment sequencing, suggesting potential unmet need with current therapies. Further insight into patient, clinical and community-level factors guiding treatment decisions in the real world is needed. [Table: see text]
Drivers and barriers to information seeking: Qualitative research with advanced cervical cancer patients in the United States.
Authors: Szamreta Elizabeth A. , Wayser Graceanne R. , Prabhu Vimalanand S. , Mulvihill Emily , Stockstill Katherine , Salani Ritu
Published: June 2021

e18705

Background: Patients diagnosed with persistent, recurrent, or metastatic cervical cancer (CC) may face uncertainty about treatment options, impact of treatment on health & quality of life (QoL), & available resources. This study provides insight into patient concerns & information seeking (IS) behaviors. Methods: In January 2021, semi-structured telephone interviews were conducted in the US with CC patients (diagnosed within 2 years) recruited through panels, social media & advocacy groups. The interview focused on rational & emotional drivers and barriers for IS. Transcripts were coded using NVivo qualitative analysis software to identify key themes. Results: 14 women of varied education status were interviewed (mean age 51 years (range: 37-70); 8 White, 4 Black, & 2 Latina). Patients emphasized trust in their oncologist to provide sufficient information. IS was driven by the desires to confirm their oncologist’s recommendation & find reassurance through the experience of other patients, and encouragement from family. Barriers to IS included: 1) hesitancy to undermine their oncologist’s recommendations, 2) pessimism about ability to find individualized answers about prognosis or QoL, 3) feeling overwhelmed & fearing mis-information, 4) personal urgency to decide on a treatment plan, 5) already having sufficient information, 6) potential exposure to “negative energy” from online patient communities, & 7) COVID-19 hindering opportunity for personal connections. Conclusions: While patients’ oncologist, family, & common patient experience provide comfort, reluctance towards IS exists. As trusted gatekeepers, oncologists should recognize patients’ desire for accessible, reliable, & personalized information. Better understanding this perspective and gaps in the availability of validated & relevant resources can enable clinicians/policy makers to develop strategies & tools for better communication. In turn, this will help CC patients feel more empowered & informed throughout their cancer care journey.[Table: see text]