bluuebunny/crossref_metadata_2025_split huggingface dataset:
Examining variation in mammography and breast cancer treatment quality.
Authors: Dupuy Danielle , Orsi Jennifer M. , Rauscher Garth , Murphy Anne Marie , Weldon Christine B. , Trosman Julia R. , Robinson Patricia A. , Marcus Elizabeth A. 
Published: March 2020

e16531 Background: In Chicago, Illinois, black women are 62% more likely to die from breast cancer (ca) than white women, a disparity exceeding that of the US (41%) and New York City (27%). Geographically disparate rates may suggest health system drivers of the disparity. The Chicago Breast Cancer Quality Consortium was established in 2008 to examine the quality of screening and breast cancer care to answer the question of whether variations in quality contribute to the known disparity while identify opportunities for quality improvement interventions. Methods: Mammography (mammo) screening data was collected from each site. Treatment (tx) data for each woman with a primary breast ca diagnosis who received her first course of tx at that site was collected. Measures, methods and benchmarks were developed using existing guidelines and approved by expert advisory groups. Analysis was performed to determine if sites could demonstrate they met benchmarks. Results: CY2009 aggregate screening and tx data was collected from 52 and 21 sites respectively. Only 61% (32) of sites could demonstrate that they met >50% of the screening mammo benchmarks, while 76% (16) of sites could demonstrate they met >50% of tx benchmarks. Conclusions: A lower proportion of sites could show they meet quality mammo benchmarks as compared to tx benchmarks. There was room for improvement in both. Further site-specific inquiry is underway to determine if results are reflective of data collection issues or actual quality issues. [Table: see text] [Table: see text]
Perceptions concerning clinical trials in oncology patients.
Authors: Lee Dana , Chao Ju-Hsien , Stevens Sandy , Kloecker Goetz H. 
Published: March 2020

e16533 Background: Accrual to clinical trials among adult cancer patients is persistently low. Patient preference plays an important role in enrollment. To identify the reasons why patients decline study participation, it is important, to evaluate the perceptions of newly diagnosed oncology patients about clinical trials. Methods: Patients were given a ten-question survey reflective of their attitudes regarding clinical trials as a treatment option at their initial visit. The self-directed questionnaire was scored on an ordinate scale from strongly agree (1) to strongly disagree (5). Results: Ninety-two new patients were surveyed in the cancer - specific multispecialty clinics in an academic cancer center. The patients expected information relating to eligible clinical trials and privacy protection by university sponsored studies as they strongly concurred with “I expect my doctor to inform me about clinical trials that I am eligible for” (mean score 2.15, p=0.001) followed by “all possible measures to protect my privacy are likely to be taken in a clinical trial that is sponsored by a university” (2.36, p=0.36). The strongest disagreement was “If enrolled in a clinical trial, I am comfortable being assigned by a method such as ‘flipping a coin’ or ‘throwing a dice’” (3.73, p=0.001) and “I would be willing to participate in a clinical trial as a first line treatment option” (3.50, p=0.001). Industry sponsored trials, phase 1 trials, second line treatment trials, privacy concerns and investigator initiated trials and time commitment and altruistic reasons did not significantly deviate from the mean preference (2.5) by a one sample T-test analysis. Conclusions: Patients consider the option of clinical trials as important in their treatment, and expect to be informed by their oncologist about clinical trials. Newly diagnosed cancer patients perceive randomization and first line trials negatively. Since randomized data provides new standards for care and hope for improved treatment, patients and their families must be educated about their importance.
Cost-effectiveness of robot-assisted lobectomy compared with VATS lobectomy for early-stage lung cancer in the National Health Insurance Program of Korea.
Authors: Lee Hyun-Sung , Jang Hee-Jin , Park Seong Yong , Joo Jungnam , Zo Jae Ill 
Published: March 2020

e16534 Background: Robotic surgery has proven to be one of the most effective cutting-edge technologies for successful minimally invasive surgery. This study aimed to evaluate the cost-effectiveness of robot-assisted lobectomy (RAL) for the treatment of early stage lung cancer with video-assisted thoracic surgery (VATS) lobectomy. Methods: From February 2009 to April 2011, one hundred twenty patients underwent RAL for clinical stage I or II non-small cell lung cancer. The consecutive 100 patients who underwent RAL were compared with 100 patients who underwent VATS lobectomy during the similar period under intent-to-treat analysis. Clinicopathologic characteristics and surgical outcomes were analyzed. Adverse events were defined as operative morbidities, mortality and conversion to open thoracotomy. The adverse events were adjusted by NCI-CTCAE 3.0 grade. Incremental cost-effective ratio (ICER) was defined as difference of total cost divided by difference of adjusted adverse events. Results: Tumor size was slightly larger in RAL group with 3.2cm in mean size of tumor. RAL needed longer operation time than VATS group. However, the console time during operation was similar with operation time in VATS lobectomy. The median length of postoperative stay was significantly shorter after robotic surgery than VATS. Operative morbidities developed in 9 patients in RAL and 21 in VATS (p=0.028). Conversions to thoracotomy were happened in 2 cases in RAL and 7 cases in VATS (p=0.170). The total hospital costs were higher in RAL than those in VATS ($14,186 vs. $11,509, p<0.001). ICER between RAL and VATS was $16,111 (80% CI; $9,190~$33,860) and NNT (numbers needed to treat) was 6.01. If six patients are treated by RAL, one case of adverse operative events could be diminished and its additional cost is $16,111. Conclusions: Robot-assisted lobectomy for early stage lung cancer is safe as well as feasible, and it results in a satisfying postoperative outcome compared with those after VATS lobectomy. Despite higher total costs, RAL is highly cost-effective to treat early stage lung cancer in National Health Insurance Program of Korea.
Examining the impact of frequent versus infrequent screenings for breast cancer on employer costs.
Authors: Nair Kavita V. , Ghushchyan Vahram , Thompson Lisa A , O'Bryant Cindy L. , Allen Richard Read , McQueen Robert Brett 
Published: March 2020

e16550 Background: Studies have shown an effective way to reduce breast cancer mortality is through early detection with periodic mammographic screening. Screening can increase the likelihood that cancer is detected at an earlier stage when treatment can be more effective and less expensively. Employers may be motivated to improve screening efforts if it results in improved survival and lower healthcare costs. We estimated differences in breast cancer and all cause related costs for women between 40-65 years who received regular screenings compared to those who did not. Methods: Data obtained from the LifeLink™ Health Plan Claims Database (2000 – 2010). ICD-9 codes (174.xx and 233.xx) were used to identify women between 40-65 with a diagnosis for breast cancer, who had an mammogram in the 6 months prior to diagnosis (baseline period) and had a minimum of 12 months following the diagnosis. Two cohorts were created. Those with at least one additional mammogram in the 12 months prior to the start of the baseline period (frequent mammogram group) and those with no additional mammograms (infrequent group). Both groups were followed for a minimum of 12 months and a maximum of 10 years. Adjusted differences in breast cancer and all cause costs were examined controlling for age, chronic condition index, number of mammograms in the baseline period, region and years of follow up using generalized linear models. Results: Mean age was 54 in the frequent (n=1582) and 56 in the infrequent (n=1379) group. Infrequent group had 29.7% of women between 40-49 years compared to 23.6% in the frequent group. Majority of the frequent group (85%) had one additional mammogram in the 12 months preceding the baseline period while 15% had > 2 mammograms. Infrequent group incurred on average $5715 higher breast cancer costs in year one compared to the frequent group (p <0.001). All cause costs in year one were also $6222 higher in the infrequent group (p<0.001). Similar trends were seen in years 2-5 for breast cancer and years 2-3 for all cause costs. Differences were consistent for each year of age from 40-65. Conclusions: Our findings suggest that efforts to improve screening rates can affect employer costs for treating breast cancer between 1-5 years following diagnosis.
Immune compromization and disparities in cancer type among sexual minority men.
Authors: Kamen Charles , Gerry Arianna Aldridge , Andrykowski Michael A. , Palesh Oxana 
Published: March 2020

e16564 Background: Self-identified gay men are at higher risk for contracting HIV and other sexually transmitted infections than their heterosexual counterparts. Gay men are also at higher risk for reporting a lifetime history of cancer diagnoses. While certain types of cancers, specifically Kaposi sarcoma and non-Hodgkin lymphoma, are more common among gay and sexual minority men, it is yet unclear to what extent this disparity is due to immune compromization or comorbid infection with HIV. Methods: The current study utilized data from 173 gay and 5544 heterosexual men collected as part of the Behavioral Risk Factor Surveillance System survey conducted in 2009 in California. Items assessed lifetime history of cancer diagnosis, type of cancer, sexual minority status, and presence of a weakened immune system resulting from diseases such as HIV/AIDS. Chi-square tests were used to examine differences in rates and types of cancer diagnoses by sexual minority status. Logistic regression was then used to examine risk for reporting a lifetime history of cancer based on sexual minority status and accounting for a weakened immune system. Results: In this sample, rates of cancer diagnoses differed significantly between gay and heterosexual men, with gay men more likely to report diagnoses of cancer (χ2 = 4.53, p < 0.05, OR = 1.53). In addition, types of cancer diagnoses reported differed significantly between gay and heterosexual men, with gay men more likely to report diagnoses of oral cancer (1.2% vs. 0.1%; χ2 = 23.31, p < 0.001); testicular cancer (1.2% vs. 0.1%; χ2 = 9.84, p < 0.01); and “other” cancers (1.7% vs. 0.3%; χ2 = 9.11, p < 0.01). Notably, this disparity in cancer diagnoses persisted even when controlling for a weakened immune system (χ2 = 3.95, p < 0.05; OR = 1.80, 95% CI = 1.03 to 3.15). Conclusions: Immune system compromization accounts for some of the disparity noted between gay and heterosexual men in rates of cancer diagnoses; however, other risk factors may be implicated. Cancer screening rates for gay men should be increased, and screening physicians should specifically assess for risk factors in gay men.
Somatostain receptor (SSTR)-targeted therapy in pulmonary large-cell neuroendocrine carcinoma (LCNEC) patients with intermediate proliferation rate (PR).
Authors: Biran Haim , Perelman Marina , Bar Jair , Zwas Tzila S. 
Published: March 2020

e17509 Background: LCNEC is classified as a high-grade (HG) foregut-derived neuroendocrine tumor (NET), exceeded only by small-cell lung carcinoma (SCLC) in terms of aggressiveness. It is a recent disease entity, only two decades old, and uncommon: 2%-3% of all lung cancer cases. Therefore, therapy guidelines are still evolving. Methods: A single institution observational study, consecutive series. Histopathology diagnosis conformed to WHO criteria for thoracic tumors (Travis et al, IARC Press, 2004). Immunohistochemistry included proliferation Ki67 index evaluation. SSTRs' affinity was assessed either by 111 In octreotate SPECT, or by Ga68 DOTA-NOC octreotate PET CT total body scans. Results: We have treated nine metastatic LCNEC patients over the last four years. Seven were scanned for presence of somatostatin receptors; 4 were positive. Three of the four had Ki67 staining ranging 10-20% (intermediate PR, IPR), one had 80% (high PR). All four have received octreotide LAR as a therapy component. In two cases octreotide was given upfront and conferred PFS of 18 and 8 months and, in the former- regression of hepatic lesions. The other patient also received 177 Lutetium radionuclide therapy (PRRT) upon progression, resulting in uptake normalization at an hepatic mass and stabilization of other lesions. The 3rd patient had started with induction chemotherapy and then maintained imaging-confirmed stable disease and normal function, during octreotide treatment, for three years. The fourth, HG patient, survived only 8 months. Three of the 9 patients are alive with disease on treatment, surviving 25+, 57+ and one, with 50% proliferation index and a negative DOTANOC scan, has survived 16+ months, with no targeted therapy. Conclusions: This small series illustrates the diagnostic value and therapeutic implication of SSTR scans, combined with Ki67 assessment, aiming at therapy selection for IPR subgroup, receptor positive, pulmonary LCNEC patients who can benefit from octreotide targeted therapy.
Clinical significance of the EML4-ALK fusion gene and association with EGFR and KRASgene mutation in 208 Chinese patients with non-small cell lung cancer.
Authors: Chen JUN , Liu Hongyu , Yang Tong , Wei Sen , Zhou Qinghua 
Published: March 2020

e17514 Background: EML4-ALK fusion gene is a potentially relevant oncogenic event in lung cancer, which represents a new subgroup of non-small cell lung cancer (NSCLC) patients who respond positively to ALK inhibitors. The characteristics of EML4-ALK fusion gene in Chinese Patients with NSCLC are poorly understood. In this study, we aimed to analyze the prevalence of EML4-ALK fusion gene and their correlation to epidermal growth factor receptor (EGFR) status, KRAS mutation, and clinico-pathological data in Chinese patients with NSCLC. Methods: Genes were detected by nested RT-PCR and confirmed by sequencing. Results: 208 cases of NSCLC were evaluated. There were 24.5% (51/208 cases of mutations in EGFR at exons 18-21, and EGFR mutations occur predominantly (92%) in exons 19 and 21. In concordance with previous reports, these mutations are identified at high frequencies in females (47.5%, 29/61 vs 15.0%, 22/147 in males; P = 0.000); never-smokers (42.3%, 33/78 vs 13.9%, 18/130 in smokers; P = 0.000), and adenocarcinoma patients (44.2%, 42/95 vs 8.0%, 9/113 in non-adenocarcinoma patients; P = 0.000). There were only 6 cases (6/208, 2.88%) of KRAS mutations in our study group. We identified 7 patients who harbored the EML4-ALK fusion gene (3.37%, 7/208) which all confirmed by DNA sequencing. Of these 7 patients, 2 cases displayed the EML4-ALK variant 1 (28.6%), 1 case exhibited variant 2 (14.3%) and 4 cases carried variant 3 (57.1%). All of the positive cases corresponded to female patients (11.5%, 7/61). Six of the positive cases were non-smokers (7.69%, 6/78). The incidence of EML4-ALK translocation in female non-smoking adenocarcinoma patients is as high as 15.2% (5/33). No EGFR/KRAS mutations were detected among EML4-ALK positive patients. The meta-analysis demonstrated that EML4-ALK translocation was 4.71% (125/2652) in unselected patients with NSCLC, and was also predominant in female patients with adenocarcinoma. Conclusions: EML4-ALK translocations are infrequent in the entire NSCLC patient population, but are frequent in the NSCLC patient subgroup of female, nonsmokers, and adenocarcinoma patients.
Hybrid scheme with carboplatin and etoposide intravenous (iv) and oral in patients with small cell lung cancer: Should we treat in a different way based on the age?
Authors: Ruiz-Valdepeñas Andrea , Palka Magda , Ibeas Patricia , Doger de Speville Bernard Gaston , Almagro Elena , Perez Callejo David , Huelves Miriam , Lopez-Gonzalez Ana , Maximiano Constanza , Mendez Miriam , Nuevo Gema , Provencio-Pulla Mariano 
Published: March 2020

e17515 Background: The increase in longevity due to a better quality of life in old people makes possible the chemotherapy treatment in the most of patients with Small Cell Lung Cancer. The aim of this research is to evaluate if there are differences in overall survival according to the age (comparing older and younger than 65 years old), in patients treated with the same scheme of chemotherapy. Methods: Patients diagnosed with small cell lung cancer between years 2003 and 2010 and treated in our hospital by the scheme carboplatin 300mg/m2 IV on day 1, with etoposid 100mg/m2 per day (iv on day 1 and oral days two to five), were retrospective reviewed to evaluate the overall survival by group of age (older and younger than 65 years old). Results: 96 patients diagnosed of small cell lung cancer were treated in our hospital between 2003 and 2010 with the aforementioned scheme of chemotherapy. 70 of them were on extended stage, and 26 had limited stage; 54 were until 65 years old (56.25%) and 42 were older (43.75%). In extended disease, the elder than 65 presented an overall survival rate one year after the diagnosis of 38.3% (SE 9.3%) and at 18 months 10.2% (SE 6.3%), with a median overall survival of 10 months (Range 1 to 22 months). The younger than sixty five had an overall survival at 12 months of 23.8% (SE 6.6%), and at 18 moths of 5.4 (3.7%), non significant (p:0.437). Their median overall survival was 8.23 months, with a range of <1month to 24 months. In the group with limited stage, the sample older than 65 had a probability of overall survival 1 year after the diagnosis of 46,2% (Standard error (SE), 13.8%), and 23.1% (SE 11.7%) at 18 months, versus a 48.6% (SE 14,8%) at 12 months and 19.4% (SE 12.2%) in younger (p:0.708). The median overall survival in elder than 65 with Limited stage was 11.5 months (6 to 81 months), and for the younger 15 months (range 4 to 25 months). Conclusions: The hybrid scheme carboplatin 300mg/m2 IV on day 1, with etoposid 100mg/m2 per day (iv on day 1 and oral days 2 to 5), provides an acceptable overall survival, without significant differences comparing older and younger than 65 years old, both in limited and extended stage.
Phase II study of perioperative chemotherapy with cisplatin (C) and pemetrexed (P) in non-small cell lung cancer (NSCLC).
Authors: Farooq Aamer , Dy Grace K. , Demmy Todd L. , Bogner Paul , Nowadly Cynthia , Tan Wei , Chen Hongbin , Yendamuri Saikrishna S. , Nwogu Chukwumere E. , Bushunow Peter Walter , Adjei Alex A. , Ramnath Nithya 
Published: March 2020

e17535 Background: Pathological complete response (pCR) with neoadjuvant chemotherapy is associated with improved survival in many solid tumors. We evaluated efficacy and tolerability of neoadjuvant plus adjuvant C+P in this phase II trial. Methods: We recruited patients (pts) with clinical stage IB-IIIA (TNM 7th ed) NSCLC, ECOG performance status (PS) 0-1 in this single-arm phase II trial using two-stage design with 90% power to detect pCR rate of >10% (vs null hypothesis of <2%). Pre-treatment mediastinal biopsy was required. Protocol was amended in 2009 to exclude squamous histology. Pts received 3 cycles of C 75mg/m2 + P 500mg/m2 (day 1 every 21 days) followed by surgical resection. Two cycles were delivered adjuvantly within 60-80 days after surgery. The primary end point was pCR. Secondary endpoints were objective response rate (ORR), overall survival (OS), disease-free survival (DFS), and adverse events (AEs). Results: 38 pts were enrolled with median age of 62 yrs, 19 males: 19 females. 74% (N=28) had ECOG PS 0. Preoperatively, 26% (N=10) had squamous histology, 29% (N=11) had biopsy-proven N2 involvement. Median of 4 cycles were administered. ORR was 29% (11 pts with PR). 4 pts did not undergo surgery (3 had disease progression; one became hypoxic during intubation in the OR). Resection status was R2 in 9% (3 of 34 pts), remaining pts had R0 resection. 6 pts had documented N2 clearance; median DFS (mDFS) and OS (mOS) of these pts have not reached (NR) vs 15 and 24 months respectively, in pts with persistent N2 disease. CTC grade 3+ nonhematologic AEs (<10%) include arterial thrombosis, bronchopleural fistula, empyema, hyperglycemia, fatigue and tinnitus. There was no pCR seen and thus accrual to 2nd stage was not pursued. There was no correlation between DFS or OS with ORR or pre-operative stage. There was statistically signification association between DFS with histology (favoring squamous, p=0.03) and post-op stage (p=0.024). The table shows mDFS and mOS in months according to pre-op stage. Conclusions: While the primary endpoint was not met, this regimen is active and well-tolerated perioperatively in NSCLC pts. [Table: see text]
Gene-expression profile of primary non-small cell lung cancer associated with brain metastasis: A prospective study.
Authors: Arrieta Oscar , Saavedra-Perez David , Ortega Alette , Rangel Claudia , Aviles-Salas Alejandro , Zavala Diego G , Mercado Gabriela , De La Garza Jaime G. 
Published: March 2020

e18028 Background: Brain metastases (BM) occur in 30-50% of non-small cell lung cancer (NSCLC) patients and confer worse prognosis and quality of life. Better selection of in-risk patients through an accurate biomarker could improve the benefit of prophylactic therapies. The aim of this prospective study was to determine a gene-expression profile (GEP) of primary tumor (PT) associated with BM in patients with advanced NSCLC. Methods: From January 2009 to June 2011, patients with stage IV of NSCLC were evaluated. PT core biopsy was performed prior to any treatment and snap-frozen. Samples with tumor cellularity > 70% and RNA integrity number > 8 were chosen for RNA isolation. A cDNA microarray platform representing 33,297 genes was used to obtain GEPs. All patients received standard chemotherapy. BM were confirmed by magnetic resonance imaging. Non- and supervised hierarchical clustering methods were employed to identify GEPs. Results: A total of 29 patients were enrolled, 79.4% (23/29) were adenocarcinomas, and 20.6% have other histology. BM were present in 15 (51.7%) patients, 14 at diagnosis and 1 was developed at 5 months of follow-up. Clinical characteristics were similar for patients with and without BM. At non- and supervised analyses, 35 genes up and down regulated were evidenced in BM group. From these, 11 transcripts with proteomic functions previously associated with metastasis processes were identified. Conclusions: Our work provides valuable biological information for development of predictive biomarkers for metastatic brain tumors from primary NSCLC. External validation of our gene-expression signature in a different set of patients is warranted. [Table: see text]