bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-reported physical and mental health of socioeconomically disadvantaged cancer patients.
Authors: Gehr Aaron , Lu Yan , Tanna Bhavna , Narra Kalyani , Ghabach Bassam , Ojha Rohit P. 
Published: May 2020

e19041 Background: Patient-reported outcomes (PROs) are extensively described for cancer patients with access to care, but little information is available about PROs for socioeconomically disadvantaged cancer patients with barriers to care. Therefore, we aimed to compare patient-reported mental and physical health between newly diagnosed cancer patients at an urban safety-net cancer center and the general population. Methods: We used data collected during implementation of a quality improvement pilot initiative to integrate PROs into clinical care at the JPS Oncology and Infusion Center (Fort Worth, TX), which is a Comprehensive Community Cancer Program. The Patient-Reported Outcomes Measurement Information System (PROMIS) 10-item Global Health Survey was used to ascertain mental, physical, and social health for newly diagnosed cancer patients between August and December 2019. Our outcomes of interest were the mental and physical health subdomains. We computed T-scores, where a score of 50 represents the mean for the U.S. general population with a standard deviation (SD) of 10. We defined severely impaired health as subdomain scores ≥2 SDs below the mean. In addition, we estimated standardized morbidity ratios (SMR) and corresponding 95% confidence limits (CL) to compare the observed number of patients with severe impairment of mental or physical health with the expected number of patients with severe impairment. For example, an SMR = 1.0 implies that the observed number of severely impaired individuals in the study population is equal to the expected number in the general population. Results: Our study population comprised 59 patients, of whom 73% were aged < 65 years, 51% were female, and 54% were racial/ethnic minorities. Breast (21%) and lung (21%) cancers were the most common diagnoses. The frequency of severely impaired physical health for our population was 4.4 times higher than the general population (SMR = 4.4, 95% CL: 1.6, 9.6), whereas no patients in our study population reported severely impaired mental health (SMR = 0, 95% CL: 0, 2.2). Conclusions: Our results suggest that socioeconomically disadvantaged cancer patients have substantially impaired physical health but not mental health at diagnosis. These findings may be useful for raising awareness about the importance of systematically ascertaining PROs and using the results to allocate resources for delivering care to safety-net cancer patients.
Real-world biomarker testing practices in cancer treatment in a lower-middle income country in Southeast Asia.
Authors: Catedral Lance Isidore Garcenila , Tan Harold Nathan , Chua Alfredo Viray , Sacdalan Danielle Benedict Leoncio , Sacdalan Dennis 
Published: May 2020

e19042 Background: Several factors affect how medical oncologists in the Philippines, a lower middle income country, incorporate biomarkers in real-world practice. This study described patterns of use of biomarker testing for the management of breast, colorectal, and lung cancers among medical oncologists in the Philippines, where treatment is largely out-of-pocket. Methods: A cross-sectional survey was performed among practicing medical oncologists in the Philippines from November to December 2019. Responses were compiled and summarized using descriptive statistics. Results: A total of 127 responses (about 40% of medical oncologists in the country) were collected. Respondents were both consultants and fellows-in-training who, on the average, had been in oncology practice for 6.64 years (SD 7.37). Majority of respondents were affiliated with private hospitals and/or clinics (62.20%), but 40.94% of medical oncologists worked in academic medical centers. If clinically indicated and if cost did not play a role, 96% of respondents would order ER, PR and HER2neu testing for breast cancer. A quarter of respondents would include Ki-67 testing. In actual practice, 97% of the respondents reported ordering for ER/PR and 93% for HER2neu testing. For lung cancer, respondents would use EGFR (97.76%), PD-L1 (88.19%), ALK (80.31%), ROS1 (58.27%), and BRAF (33.07%). In actual practice, EGFR was the most frequently ordered biomarker (67.72%). 44.80% of medical oncologists had never used ROS1. For colorectal cancer, the respondents would use KRAS (98.43%), NRAS (81.89%), MMR/MSI (82.25%), and BRAF (63.78%), but these were only sometimes used. 59.84% of medical oncologists had never used BRAF. The strongest factor that drove medical oncologists to test for biomarkers was adherence to clinical practice guidelines (96%), with most respondents using international guidelines from the United States and Europe (61.4%). The largest barrier to biomarker use in the Philippines was financial constraints (94.5%), followed by the patients’ unwillingness to be tested (59.1%), and unavailability of tests in the areas of practice (58.27%). Conclusions: Medical oncologists in the Philippines would use biomarkers in the management of breast, colorectal, and lung cancers if these were clinically indicated and if cost did not play a role. Biomarker use was largely driven by American and European clinical practice guidelines. Financial difficulties by patients, who often had to resort to out-of-pocket payments for their treatment, formed the largest barrier to biomarker use.
Population-based analysis of guideline adherence for patients with rectal cancer in California.
Authors: Del Rosario Michael , Chang Jenny , Ziogas Argyrios , Clair Kiran , Bristow Robert E. , Tanjasiri Sora Park , Zell Jason A. 
Published: May 2020

e19045 Background: The goal of oncology-specific evidence-based treatment guidelines is to improve cancer care. We sought to analyze adherence to National Comprehensive Cancer Network (NCCN) treatment guidelines for rectal cancer in the state of California and the associated impacts on survival. Methods: Patients aged 18 to 79 years diagnosed with rectal adenocarcinoma between January 1, 2004 and December 31, 2017 with follow-up through November 30, 2018 were identified in the California Cancer Registry. Patient characteristics such as age, race, insurance status, socioeconomic status (SES), marital status, and tumor stage were identified. In addition, based on available data our investigators determined whether patients received NCCN guideline-adherent care. Odds ratios (OR) and 95% confidence intervals (CI) were used for logistic regression to analyze patients receiving NCCN adherent care. Disease specific-survival analysis was calculated using Cox regression model. Results: A total of 30,118 patients identified with diagnosis of rectal cancer in California, 16,442 (54.6%) of whom did not receive guideline-adherent care. Disease specific-survival was worse for those who did not receive NCCN adherent care with hazard ratio (HR) 1.52 (95% CI 1.41 - 1.63, p < 0.0001). Compared to Caucasians as a referent group, Asians (in aggregate) were more likely to receive guideline adherent care and had better disease specific survival with adjusted HR 0.88 (95% CI 0.80 -0.97, p = 0.008). Also compared to Caucasians, Hispanics were more likely to receive guideline adherent care and had better disease specific survival HR 0.90 (95% CI 0.83 – 0.98, p < 0.015). As compared to managed care insured patients, uninsured patients were least likely to receive care and were observed to have worse disease specific survival adjusted HR 1.34 (95% CI 1.18 – 1.54, p < 0.0001). Patients with Medicaid were also significantly associated with lower survival HR 1.39 (95% CI 1.26 – 1.53, p < 0.0001) – and the CIs indicate Medicaid and uninsured were not statistically different from each other. Comparing to patients with highest SES as a referent group, patients with lowest SES were least likely to receive guideline adherent care and also were observed to have worse disease-specific survival with HR 1.22 (95% CI 1.09 – 1.36, p < 0.0004). Conclusions: In this population-based analysis of rectal cancer patients in California, guideline-adherent care was associated with improved survival.
Esophageal cancer: How far is close enough?
Authors: Elliott Leighton Andrew , Vadakara Joseph 
Published: May 2020

e19049 Background: According to Surveillance, Epidemiology, and End Results (SEER) data, 5-year survival of esophageal cancer (EC) improved from 4.1% to almost 20% from 1975 to 2016, however, this is still poor compared to other cancers. Chitti et al describe temporal changes in EC mortality by geographic region across the United States (U.S.) and concluded that disparities exist. Other studies described survival disparities for rural communities specific to small cell lung carcinoma, cervical cancer, and breast cancer. Hung et al determined that 1 in 5 rural Americans lived > 60 miles from a medical oncologist. Studies performed outside of the U.S. described no difference in survival with travel distance. No studies on this topic have focused on gastrointestinal malignancy. Our study aimed to associated travel distance with travel time to a medical oncology treatment center as time can vary greatly with similar distances. We focused specifically on esophageal cancer considering its high mortality rate and significant effect on quality of life. Methods: We performed a descriptive analysis of a retrospective cohort (January 2008 – August 2019) of all individuals diagnosed with esophageal cancer using data from the institutional Oncology Tumor Registry, a regional cancer registry, and the electronic health records (EHR) of patients throughout a rural integrated health system in Pennsylvania. We geocoded home addresses using Google Maps Geocoding application programming interface (API) and the average driving distance and time to the nearest medical oncology treatment center was calculated using the Google Maps Distance Matrix API. Travel time compared to cancer stage was also assessed. Addresses listed over 100 miles were evaluated for documentation accuracy via the EHR. Results: A total of 1157 adult patients diagnosed with esophageal cancer was evaluated; of these, 433 had a documented outpatient chemotherapy infusion site visit. The mean travel distance to a medical oncology treatment center was 19.8 miles with a median of 16 miles; this correlated with a mean travel time of 28.2 minutes. Seventy-five percent of the population lived within 26 miles of an outpatient oncology center. The maximum distance traveled was 139 miles, which was confirmed via EHR chart review. Conclusions: This study shows that a rural population may not necessarily experience disparity in travel distance and time to a medical oncology treatment center. This was an exploratory study and further analysis will be needed to see if there was any statistically significant difference in survival based on distances when stratified by stage, age, treatment modality, etc.
A comparative study on costs of cancer and access to medicines in Europe.
Authors: Wilking Nils Erik , Brådvik Gunnar , Lindgren Peter , Svedman Christer , Jönsson Bengt , Hofmarcher Thomas 
Published: May 2020

e19051 Background: Cancer care is evolving rapidly, and costs and value of new treatments are often causing headlines without being discussed in a larger context. This study estimates the cost of cancer and access to medicines in Europe in 2018 and extends a previous analysis for 1995–2014. Methods: Cancer-specific health expenditure for 31 countries (EU-27 plus Iceland, Norway, Switzerland, and the UK) were derived from national estimates. Data on cancer drug sales were obtained from IQVIA. The productivity loss from premature mortality was estimated from data from Eurostat and the WHO. Estimates of the productivity loss from morbidity and informal care costs were based on previous studies. Results: The total cost of cancer was €199 billion in 2018. Total costs ranged from €160 per capita in Romania to €578 in Switzerland (after adjustment for price differentials). Health expenditure on cancer care was €103 billion, of which €32 billion was spent on cancer drugs. Informal care costs were €26 billion. The total productivity loss was €70 billion, composed of €50 billion from premature mortality and €20 billion from morbidity. Between 1995 and 2018, cancer incidence increased by 50 percent from 2.1 million to 3.1 million cases in Europe. Cancer mortality increased only by 20 percent. Health spending on cancer care doubled from €52 billion to €103 billion (in 2018 prices and exchange rates), whereas the share of cancer care on the total health expenditure remained stable at around 4 to 7 percent. A shift from treatment in inpatient care to ambulatory care has probably saved costs. Expenditure on cancer medicines more than tripled from €10 billion to €32 billion between 2005 and 2018 (excluding confidential rebates). Productivity loss from premature mortality decreased over time, linked to mortality reductions in working-age patients. Conclusions: There are large country differences in spending on cancer care and outcomes in Europe. Access to new cancer medicines is low or very low in certain parts of Europe. Inequalities are mainly related to countries’ economic strength and not to the disease burden of cancer.
The complex comorbidities of uninsured cancer patients.
Authors: Shah Shreni , MacDonald Madeline , Lu Yuanyuan , Pabbathi Smitha , Mirza Abu-Sayeef 
Published: May 2020

e19054 Background: Uninsured patients diagnosed with cancer receive fewer screenings, frequently present with later-stage cancer, and are often unable to access standard-of-care treatment when compared to insured patients. We previously performed a study demonstrating that uninsured patients with cancer histories have higher levels of comorbidity. However, there is limited data on long-term studies describing comorbid chronic conditions among uninsured cancer patients. Here we examine socioeconomic factors and comorbid chronic conditions in uninsured patients with a cancer history over a period of three years. Methods: A retrospective chart review was conducted from 10 free clinics around the Tampa Bay region. Patients with any documented history of cancer who utilized a free clinic between 2016 and 2018 were included. Patients with no documentation of cancer history were excluded. Demographics, chronic disease parameters, and Charlson Comorbidity Index (CCI) scores were extracted and analyzed. Results: Between 2016 – 2018, a total of 17,003 uninsured patients were treated at 10 free clinics. Of these patients, 455 (2.7%) had a documented history of cancer, 9021 (53.1%) had no history of cancer, and 7527 (44.3%) had no documentation of cancer in their charts. Cancer patients were mostly women (305, 67.0%) and the average age was 55.2 years. Patients with cancer had significantly higher CCI scores compared to patients without cancer in 2016 (3.0 [2.0 SD] versus 0.94 [1.2 SD]), 2017 (2.71 [2.38 SD] versus 0.93 [1.26 SD]), and 2018 (3.27 [2.22 SD] versus 1.08 [1.26 SD]), p < 0.001. Patients with a cancer history were also more likely to be current drinkers (16.9% versus 13.0%) or smokers (17.8% versus 11.0%) compared to patients without a history of cancer. Conclusions: The results demonstrate that uninsured cancer patients consistently have higher levels of chronic disease and comorbidity compared to uninsured patients without a cancer diagnosis. This study increases awareness of the disease burden and mortality risk specific to uninsured cancer survivors which could inform free clinics and volunteer providers to better address the needs of this vulnerable population.
Gynecologic oncology, gender and relevant leadership in academic medicine.
Authors: Temkin Sarah Madhu , Rubinsak Lisa , Benoit Michelle F. , Chandavarkar Uma , Hong Linda , Berry Laurel K , Heisler Christine A , Rimel BJ , McGuire William P. 
Published: May 2020

e19056 Background: Within academic medicine, there has been increasing attention to diversity and inclusion. We sought to characterize gynecologic oncologist (GO) faculty inclusion, with attention to gender in relevant academic leadership roles. Methods: Using the American Association of Medical Colleges list of accredited schools of medicine academic institutions were identified. Observational data was obtained through institutional websites in 2019. Results: Of 154 accredited medical schools, 144 contain a department of obstetrics and gynecology (OBG) with a chair; 103 a GO division with a director; 98 a clinical cancer center with a director. GO divisions included an average of 3.1 faculty. 55% of GO faculty were women, compared to 66% of OBG faculty (p < 0.01). 38% of the GO division directors were women which was an under-representation (p < 0.01). GOs made up 10% of OBG faculty and 15.4% of OBG chairs (NS). Women GOs made up 7.9% of women OBG faculty and 8 (5.6%) women GOs were OBG chairs (NS). 9.9% of GO faculty (11.6% of women GO faculty) report to women GOs at the chair level. OBG departments with a GO chair were more likely to have a woman GO division director (68.4 vs 31.7%, p < 0.01), and GO fellowship (59.1 vs 32%, p < 0.01). The majority (59%) of cancer centers directors were medical oncologists (see Table). 2 (2%) of cancer center directors were GOs; 1 at an NCI designated cancer center. Neither GO directors were women. Incidence to leadership and mortality to leadership ratios were calculated compared to expected rates by SEER 2019. By these measures GOs were underrepresented in cancer center leadership (p < 0.01, p < 0.01). Conclusions: Despite representative leadership of GO and women GO within in OBG leadership, most GOs report to non-oncologists at the department chair level. Potential benefits of GO leadership within OBG departments were identified. The practice of gynecologic oncology includes complex medical and surgical cancer care making these physicians uniquely qualified for cancer center, but representation of GOs in cancer center leadership is low and women GO were absent from cancer center director positions. Without inclusion of GO in cancer center leadership, existing inequities in clinical care, research and funding for gynecologic malignancies may be amplified. [Table: see text]
Racial disparities in obesity and comorbidities among women with early breast cancer.
Authors: Nyrop Kirsten A. , Deal Allison Mary , Muss Hyman B. , Damone Emily , Lorentsen Michael , Brenizer Tucker , Shachar Shlomit S. 
Published: May 2020

e19061 Background: Both comorbidities and obesity (body mass index/BMI 30 or higher) are observed in women at the time of early breast cancer (EBC) diagnosis. This study investigates age and obesity and their association with disparities in comorbidities between black and white women at EBC diagnosis. Methods: This is a retrospective chart review of women with EBC (Stage I-III) treated at a single institution. Relative risk (RR) with 95% Confidence Interval (CI) for individual comorbidities are calculated for black compared to white patients, adjusted for age and BMI. Results: In a sample of 548 women, 26% are black and 74% are white. 18% of black patients vs 28% of white patients were age 65 or older (p = .01). 62% of black vs 33% of white patients had obesity (p < .0001). 63% of black vs 47% of white patients had 2 or more total comorbidities at diagnosis (p = .003). 33% of black vs 10% of white patients had 2 or more obesity-related comorbidities (p < .0001). 60% of black vs 32% of white patients had hypertension (p < .0001); 23% of black vs 6% of white patients had diabetes (p < .0001); and 28% of black vs 18% of white patients had high cholesterol (p = .02). In multivariable (MV) analysis adjusted for age and BMI, black women had 45% higher risk for hypertension [RR 1.45 (1.19-1.75), p = .0002)] and 44% higher risk for diabetes [RR 1.44 (1.02-5.86), p < .0001)] at EBC diagnosis. However, after adjustment, differences by race were no longer seen for > = 2 total comorbidities, > = 2 obesity-related comorbidities, heart disease, or thyroid disease. Conclusions: This study documents significant disparities between black and white women with EBC with regard to high rates of obesity, overall comorbidities and obesity-related comorbidities. Future research should assess the potential impact of weight management (avoiding weight gain) interventions in the first 2 years post diagnosis on improving OS and BCSS among patients with obesity and in reducing OS and BCSS disparities between black and white women.
Medical oncologists’ perceptions of clinical trials for underrepresented populations.
Authors: Perez Giselle Katiria , Park Elyse R. , Horick Nora K. , Mizrach Helen , Nipp Ryan David , Crute Sydney , Chabner Bruce Allan , Moy Beverly 
Published: May 2020

e19062 Background: Ethnic/racial minorities and socioeconomically disadvantaged patients remain underrepresented in cancer clinical trials (CCT), challenging the accuracy and generalizability of findings. While oncologists’ recommendations influence trial participation, we know little about their perspectives on recommending CCT to underrepresented patients. Methods: From 9/16-5/19 we conducted a sequential mixed methods study to assess oncologists’ attitudes toward recommending underrepresented patients for CCT. We performed individual interviews with 17 oncologists, developed a survey instrument, and surveyed a randomly selected sample of 98 oncologists (from ASCO, NCORP, MGH; RR = 31.2%). Descriptive statistics summarized attitudes, practices and challenges with trial enrollment of underrepresented patients. Results: Content analysis of interviews (age = 46.9, female = 37.5%, white = 75.0%) revealed overall support for CCT. Indeed, 84.4% of survey respondents (age = 53.3, female = 31.3%, white = 78.6%) considered CCT as central to their professional identity. Yet, 37.5% agreed CCT placed undue burden on oncologists. Oncologists’ concerns around informed consent and perceived lack of clinical/personal equipoise discouraged recommending CCT participation to vulnerable patients. Interviews revealed that nearly all believed that patients with certain vulnerabilities (e.g., literacy, social, financial barriers) had needs that conflicted with CCT demands, increasing the potential for harm. Oncologists were less likely to recommend CCT to patients who do not reliably report side effects (91.2%), demonstrate difficulty comprehending the costs/benefits of CCT (88.7%), lack support (87.6%), live far away (76.3%), or face insurance obstacles (73.2%). Notably, 67.7% affirmed they presented trials with varying enthusiasm based on perceived patient challenges; 32.4% deemed it hard to justify enrolling patients if efficacious standard treatment options exist outside of trials. Oncologists desired navigation support (63.3%) to offset concerns and facilitate trial discussion/enrollment. Conclusions: Findings confirm that oncologists value CCT; however, they experience conflict when considering CCT for patients with pre-existing hardships. Time constraints interfere with oncologists’ ability to adequately address and overcome perceived challenges to participation. Our findings underscore the need for programs that integrate informational support with patient navigation to increase enrollment of underrepresented patients into CCT.