bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delayed PET/CT scanning in locally advanced squamous cell carcinoma of the head and neck (SCCHN) receiving definitive chemoradiation: Outcomes and management of “incidental” findings.
Authors: Alluri Sunitha , Yunes Michael J , Cassells Lucinda J , Kaufman Seth , Napier Thomas , Mertens Wilson C. 
Published: May 2020

e18558 Background: Comparative PET/CT scanning 3-4 months after chemoradiation is often used to determine the need for salvage therapy, but approaches to managing incidental findings prior to, and incomplete response after, therapy vary. Methods: PET/CT scans before and 3-4 months after completion of definitive combined modality therapy for locally-advanced head and neck cancer (AJCC7 stage III-IVB) from 2008-14 were evaluated for FDG-avid masses and abnormal metabolic activity outside of the expected area of involvement, response to treatment and subsequent management. Results: Of 78 eligible patients, 72 had follow-up scans. Scans prior to therapy demonstrated abnormal FDG uptake in non-enlarged cervical lymph nodes in 17 (22%) and were upstaged. Pre-treatment scans revealed FDG-avid uptake outside of expected involvement in 23 patients (9 lung [ < 1.5 cm or ground glass], 4 GI, 3 bone [without CT correlate], 3 lymph nodes, 1 prostate, 1 thyroid, 3 other; 3 had multiple sites). Lung (2), bone (1) and thyroid (1) lesions were biopsied prior to therapy; on post treatment scans 20/23 demonstrated resolution while 2 had lung resections for new primaries (1 died). After therapy, 43/72 (60%) patients had a complete response (CR) without other abnormal uptake; 10/72 (14%) obtained a CR in treated areas, but developed metastases; 19/72 (26%) had persistent uptake, of whom 10 (14%) were shown to have persistent disease; 11 biopsies, 7 further PET/CT, 18 other imaging, 3 LN dissections (1 malignant) and two other salvage surgeries were performed. CR patients had a 3-year overall survival (OS) of 94%; OS was similar regardless of pre-treatment uptake. Conclusions: Minor FDG uptake outside of the head and neck on initial scanning is frequent and most of these will resolve. Persistent uptake is common 3-4 months after therapy but only half of these are persistent cancer. Patients with a normal PET/CT scan after therapy have excellent survival.
Differential immune pathways in classic and mixed variants of anaplastic thyroid cancer.
Authors: Young Hannah J , Pharaon Rebecca , Bonjoc Kimberley-Jane C. , Ally Feras , Yin Holly , Kang Robert , Gernon Thomas , Maghami Ellie , Chaudhry Ammar 
Published: May 2020

e18579 Background: Patients with anaplastic thyroid cancer (ATC) have poor outcomes due to treatment resistance with an estimated 5-year survival rate of 7%. Although “classic” ATC can arise de novo from follicular thyroid cells, it can also arise in association with papillary thyroid carcinoma (PTC), as a “mixed” histology. The immunologic and molecular differences between these histological subtypes have not been well-characterized. We aimed to investigate the differences in immune signatures in these histological subtypes to assess immune pathway differences in the classic ATC and mixed ATC/PTC tumor microenvironment. Methods: Classic ATC and mixed ATC/PTC cases (N = 12) from 1998 to 2018 with viable formalin-fixed paraffin-embedded (FFPE) tissue were identified and selected by a board-certified pathologist. 4 samples exhibited both PTC and ATC components while 8 were classic ATC cases, as confirmed by a pathologist. In the 4 mixed ATC/PTC histology specimens, 3 were identified to contain greater than 80% ATC involvement while the fourth was characterized as 40% ATC and 60% PTC. The NanoString Immune Profiling panel contains more than 770 genes. It was performed with extracted RNA to evaluate and compare the gene expression of classic ATC versus mixed ATC/PTC. Results: Majority of patients (N = 11) developed metastatic disease, a common feature of ATC, and are currently deceased (N = 10). The NanoString panel identified several differentially expressed immune pathways in the mixed ATC/PTC in comparison to the classic ATC group. There is upregulation of CD3 (p < 0.01) and CD8 (p < 0.01) transcripts in the mixed ATC/PTC group, but not CD4 transcripts (p > 0.05). Additionally, we found that genes associated with B cell and T cell function were significantly upregulated in the mixed ATC group, including CD27 (p < 0.01), CD28 (p < 0.05), BTLA (p < 0.01), CTLA4 (p < 0.01), LAG3 (p < 0.05), and TIGIT(p < 0.01). We did not observe any significant differences in the expression of PD1 (p > 0.05) or MR1 (p > 0.05) between classic ATC and mixed ATC variants. Conclusions: Our study demonstrates a significant difference in the immune landscape between classic and mixed variants of ATC. Our results indicate there may be an increase in immune cell infiltration and tumor inflammation in the mixed ATC variant, which suggests patients with the mixed ATC variant may show a positive response to immunotherapy.
Investigation of triple negative breast cancer rates in women diagnosed with breast cancer in Trinidad and Tobago.
Authors: Parkinson Gerneiva , Cooper Arianne , Alleyne-Mike Kellie 
Published: May 2020

e19005 Background: According to the WHO/PAHO, Trinidad and Tobago (T&T) has the 2nd highest breast cancer mortality rate in the Caribbean region. In T&T, citizens of African descent make up about 36.8% of the T&T population, with 24.8% being of East Indian ancestry, and 32.4% identifying as having mixed heritage. In the United States, it has been showed that African American women, despite being diagnosed less often, have an earlier onset of breast cancer with less favorable clinical outcomes. One of the factors studied has been the higher frequency of triple negative breast cancer (TNBC) in African American women particularly when these patients are diagnosed at a younger age. Notably, a large proportion of breast cancer cases in T&T appear to occur at a young age, with nearly 36% of them being diagnosed under the age of 50. However, breast cancer tumor phenotypes have not been well studied. Therefore, we sought to investigate the distribution of tumor hormone receptor markers in the T&T breast cancer population. Methods: At the National Radiotherapy Center, T&T’s main oncology unit, we investigated breast cancer patients born in T&T using paper chart reviews. We collected information about their demographics, personal breast cancer diagnosis, tumor hormone receptor status and germline genetic testing results. Results: So far, we reviewed 90 patient charts, and in our sample, 33.3% (30/90) had TNBC. This is higher than the rates in the US where TNBC accounts for 10-20% of breast cancer patients, and of those TNBC cases, 10.6% have BRCA 1 or BRCA 2 mutations. In our T&T sample, of those with TNBC, 23.3% (7/30) had a HBOC mutation (5 BRCA, 1 TP53 and 1 PTEN). Average diagnosis age of TNBC cases reported in our sample was 45.7 years. In our sample, 52.2% (47/90) identified as having African ancestry, 37.8% (34/90) identified as having East Indian ancestry and 10% (9/90) identified as Mixed. Of the patients with TNBC, 63.3% (19/30) were of African ancestry, 30.0% (9/30) were of East Indian ancestry and 6.7% (2/30) identified as Mixed. Conclusions: Therefore, our sample results suggest that there is a significant portion of the breast cancer cases being TNBC in the T&T population, particularly in citizens with African ancestry. As we continue to finalize the incoming data, we hope to draw associations between tumor pathology, clinical presentation and genetic profiles. However, these initial results demonstrate the need to study tumor pathology within the T&T population, as this could lead to improved clinical and screening guidelines specific to T&T citizens.
Outcomes of a lung cancer screening program in a Hispanic urban population: The University of Miami experience.
Authors: Gawri Kunal , Charles Marie Jeannette Jeanette , MacIntyre Jessica , Torrents Sophie , Torres Tisdrey , Villamizar Nestor , Nguyen Dao M. , Yechieli Raphael , Dawar Richa , Lopes Gilberto , Rodriguez Estelamari 
Published: May 2020

e19011 Background: The National Lung Screening Trial (NLST) revealed a 20% reduction in lung cancer (LC) mortality when low-dose computed tomography (LDCT) was utilized for LC screening vs chest radiography. NLST participants were predominantly Non-Hispanic Whites, with only 1.8% Hispanics. The goal of our study was to investigate the attributes of a LC screening program in a largely Hispanic urban population and compare with NLST. Methods: We performed a retrospective analysis of 421 consecutive cases who underwent LDCT screening from 2016-2019 at University of Miami (UM), with similar inclusion criteria as the NLST. Demographic characteristics, smoking status, lung RADS, LC detection and compliance were examined & compared with NLST cohort using summary statistics and χ2 tests for categorical variables. Results: Demographic and smoking characteristics of the UM cohort didn’t resemble those of NLST LDCT cohort. UM cohort had a different racial and ethnic profile, with a higher percentage of Hispanics (47.3% vs 1.8%) and African Americans (15% vs 4.5%) in the UM cohort vs NLST cohort respectively (p < 0.001). UM cohort generally had lesser smoking intensity, and significantly fewer active smokers when compared to the NSLT cohort; 38.5% vs 48.1% respectively. The proportion of positive LDCT screens (Lung-RADS Class 3 or 4) in the UM cohort (14.1%) was almost similar to the NLST cohort (13.7%) (p = 0.81). The UM cohort had a higher LC detection rate (3.3%) than the NLST cohort (1.1%) (p < 0.001). In keeping with goals of screening, both cohorts had 50% or more LC cases detected at an early curable stage. Overall patient adherence to screening guidelines was more than 90% in NLST cohort; whereas almost a quarter of referred patients in UM cohort didn’t show for their initial decision-making visit and only 45% completed two or more scans. Conclusions: Our LDCT screening program was based in a Hispanic urban location (UM) with 47.3% Hispanics. Compared to NLST LDCT arm, the UM cohort had fewer active smokers, lighter smoking history, a more diverse population, somewhat higher LC detection rate, weaker adherence to screening related visits. More data is needed to understand obstacles to compliance with screening in minority populations.
Pain in cancer: The patient experience in Spain.
Authors: Garcia-Foncillas Jesus , Anton Antonio , Caballero Fernando , Feyjoo Margarita , Gomez De Liano Lista Alfonso , Guillem Vicente , Monge Diana , Camps Carlos 
Published: May 2020

e19021 Background: For patients, pain management can be a therapeutic objective that is just as important as oncological treatment. The aim was to analyze the illness experience of a group of oncological patients with pain associated to cancer and episodes of breakthrough cancer pain (BTcP), as well as their opinions on the care received. Methods: This study is an initiative of the ECO Foundation (Oncology Excellence and Quality Foundation), undertaken with the methodological support of Francisco de Vitoria University. Descriptive, transversal, multicenter and ecological study. 47 oncologists participated. Each of them invited 6 patients that met the participation selection criteria (one patient every day for 6 consultation days). An anonymous patient questionnaire was used, produced by the Scientific Committee, so they could provide their personal opinions and scores on their oncological pain (categorical variables). The doctor was in charge of transcribing the aggregated data compiled by means of an online survey. Statistical package: version 21.0 IBM SPSS-Windows. Results: The 47 oncologists collected information from 275 patients whose average age was 62.4. 46.5% were women. Clinical profile of the patient: The most frequent location of the primary tumor was the lung (28%), followed by breast (15.3%) and the intestine/colon (13.1%). Almost half of the patients (46.2%) suffered from maximum intensity pain of 8 points or higher (on a scale of 0 to 10) within the last 24 hours. Despite this, 8 out of 10 patients reported that they are satisfied or very satisfied with their pain treatment. 43% of patients were worried about the possibility of addiction or side-effects as a result of the treatment. However, 95% expressed satisfaction with the information offered by their doctor regarding analgesic treatment. More than half of patients gave the impact of their pain on their general activity, mood, everyday work and enjoyment of life a score of ≥7 out of 10 (10 = completely impacted). Conclusions: Although the patient satisfaction level regarding the doctors’ pain management was high, there seems to be room for improvement in terms of pain control and the impact of pain on each patient’s life.
Characteristics and factors affecting mortality of patients admitted for chemotherapy in the United States during the year 2017.
Authors: Mariam Roy Arya , Konda Manojna , Goel Akshay , Verma Rashmi 
Published: May 2020

e19025 Background: Over the past two decades, there has been a tremendous increase in the chemotherapy options available to cancer patients. In terms of overall, progression-free survival, and temporary suppression of cancer-related symptoms, chemotherapy has shown beneficial effects. However, the side effects of chemotherapy are sometimes life threatening which affects an individual’s physical health, emotional state and quality of life. There is a considerable increase in the prevention, early identification and timely management of toxicities associated with chemotherapy; however, chemotherapy-related deaths still occur. Methods: We conducted a retrospective analysis of the National Inpatient Sample Database for the year 2017. Patients who were admitted for the administration of chemotherapy are identified using ICD- 10 codes. The epidemiology, the role of insurance providers in the treatment outcome were studied. Results: A total of 29,018 hospitalizations for the administration of chemotherapy were there in 2017. The median age of patients who received chemotherapy was 48. The overall mortality related to chemotherapy admissions was 0.80% (n = 233). The mortality of females who were admitted for chemotherapy did not vary much when compared to males admitted for chemotherapy (0.89% vs 0.73%, p = 0.132). It was found that admissions for chemotherapy during weekend had 85 % higher odds of dying as compared to admission during weekdays (1.6% vs 0.76%, OR = 1.85, p = 0.001, CI = 1.16 – 2.95). Patients who were admitted electively for chemotherapy were 74% less likely to die in hospital when compared to those who were admitted emergently for chemotherapy (1.4 % vs 0.49% OR = 0.36, p = 0.001, CI = 0.266 – 0.49). Interestingly, patients who had Medicare and Medicaid had higher mortality than those who had private insurance and self-pay when admitted for chemotherapy (2.08 % vs 0.58% vs 0.36%, p = 0.00). Those who had private insurance were 60% less likely to die in hospital while admitted for chemotherapy. The average length of stay for chemotherapy admissions were 5.92 ± 7.9%. Conclusions: Medicare and Medicaid patients, weekend admissions and emergent admissions were more likely to die in hospital while admitted for chemotherapy. Further studies are needed to reveal the disparities in the mortality of chemotherapy admissions, based on the socioeconomic status and the insurance payers.
Health disparity in Central Valley of California: Higher incidence of breast cancer in Asian population.
Authors: Sodavarapu Soujanya , Hatter Kate , Goyal Megha , Ramdass Prakash , Sayedi Majed , Obad Nashwan , Gill Amandeep Singh , Vyas Dinesh 
Published: May 2020

e19029 Background: California has the most immigrants of any state in the U.S., with approximately a quarter of the residents being foreign-born. The impact of migration on breast cancer incidences over time has not yet been characterized in the Northern Central Valley. This provides a unique opportunity to study the influence of migration, socioeconomic gradient, and racial identity on the incidence of breast cancer in San Joaquin County. Methods: This study was a retrospective, single-institution study that compared the socio-demographic variables and clinical characteristics of the patients who had a history of breast cancer in a teaching central valley hospital. We reviewed all charts with a breast cancer diagnosis from 2014-2019. We compared age, demographics, socioeconomic status comorbidities, pathology, treatment, and outcomes. Appropriate statistics have been used to analyze the data. Results: A retrospective chart review of all patients with a diagnosis of breast cancer from 2014-2019 at a central valley teaching hospital. 33.5% were white, 17.2% African American, 26.6% Hispanic, and 22.6% were Asian. Migrated Asian women are having three times increased incidence in central California compared to their peers in Asian. Additionally, those of lower socioeconomic status were more often affected (61.9% vs. 30.4% of middle-class status) in our population. Demographics and comorbidities were studied. Smoking was seen in 23.2% of patients, alcohol in 16.3%, hypertension in 43.6%, Diabetes in 18.9%, lung disease in 11.7%, and Kidney disease in 6.9%. 23.8% of the patients had a family history of cancer. Screening was only done in 41% of patients, and the distribution of race was as follows: white 10.6%, African American 7.7%, Hispanic 8.9%, Asian 8.9%. It was found that infiltrating ductal carcinoma was seen in 54.8% of patients, of which 16.1% were white, 10% African American, 15.5% Hispanic, and 13.2% were Asian. Triple-negative breast cancer was seen in 14.9% in our patient population. We further reviewed treatment methods, including chemotherapy, radiation, and surgery, as well as recurrence rates. Conclusions: We suggest that screening has to be more concentrated in all communities. The fact that the Asian population in the Central Valley shows higher rates of breast cancer could be due to epigenetic, western lifestyle, and environmental factors. Higher awareness and willingness as a subgroup may be contributing as well or there may be an actual increase; this requires further investigation, and we will present further subgroup analysis at presentation.
The effect on financial toxicity and well-being of cancer trial patients through the reimbursement of ancillary costs by the lazarex care program (LCP).
Authors: Dornsife Dana , Johnson Robert G. 
Published: May 2020

e19030 Background: Financial toxicity is a significant issue for many cancer patients (pts) and an even greater concern for pts considering a cancer clinical trial (CT) given the potential issues of distance to the trial site, additional trips to the cancer center, etc. Lazarex Cancer Foundation (LCF) has developed an efficient mechanism to quickly evaluate pts who are economically challenged and often underserved and to efficiently reimburse the non-clinical expenses (i.e. travel, lodging). Reimbursement (RI) of ancillary CT expenses can help to remove this important barrier and effect CT enrollment, retention, and diversity. Methods: Data was retrospectively reviewed from the LCP for years 2015 to 2019, and assessed for age, gender, race/ethnicity, household income (HI), type of assistance, and compared with trends from the prior 5 years. In addition, information was obtained concerning whether the RI was an important determinant in the decision to enroll or remain enrolled, the impact of RI on the pts’ well-being, and the ease/difficulty of the application and RI process. Results: During this period, 2,911 pts were approved for RI: 45% male, 55% female; 12.2% Latino/Hispanic, 7.6% black/African-American, 3.8% Asian/Pacific Islander, 72% white, and 4.3% multi-ethnic/other. The median HI was $35,000-$49,000 with 32% of the HI at less than $25,000, and 17% less than $15,000. RI expenses were distributed: 37% airfare, 37% lodging, and 26% ground transportation. There were increases in the % of minority pts and decreases in the median HI when compared with the five years prior. Questionnaires with 65% return rate of active pts indicated that 38% of pts stated that RI contributed to their positive CT decision, 92% of pts indicated RI had a significant impact (moderate to extremely high) on their sense of well-being with 82% in the high to extremely high category. 96% reported the application as not difficult to easy and only 4% noted the RI process itself as difficult. Conclusions: Accumulating data indicates that the socioeconomic financial toxicities are a significant root cause of inequitable access to CT. RI for pts upon whom the costs of participation place an undue burden, decreases their vulnerability, increases their well-being, and helps protect their rights to equal treatment. The LCF with more than ten years of experience with pt RI is currently expanding its efforts into targeted major cancer centers where all eligible pts will be enabled: the IMPACT (Improving Patient Access to Cancer Clinical Trials) Program.
Screening for health literacy at an urban academic cancer center.
Authors: Leader Amy , Waldman Lauren , Yocavitch Liana , Shimada Ayako , Cammy Rebecca , Garber Gregory D. , Worster Brooke 
Published: May 2020

e19034 Background: Low health literacy is more prevalent among older adults and minority populations, and it has been linked to excess health care utilization and poor health outcomes in cancer patients. Screening for health literacy may improve communication and care, such that discussions and information can be tailored to patient need. The purpose of this study was to describe health literacy levels and correlates among patients at an urban, NCI-designated cancer center. Methods: In September 2019, we began health literacy screening for each newly diagnosed, English-speaking cancer patient. Patients were categorized as having low, medium, or high health literacy using the BRIEF health literacy screener; results are visible in the EMR. For this analysis, we included patient age, gender, insurance type, race/ethnicity, and socio-economic status (SES), which was calculated using an Area Deprivation Index (ADI) ranging from 0 (no deprivation) to 100 (extreme deprivation). Data was summarized using descriptive statistics; ANOVA and Chi-squared tests investigated associations between patient’s health literacy levels and potential correlates. Results: Among 284 patients, 68%, (n = 195) were Caucasian, 25% (n = 70) were African American and 7%, (n = 19) identified as Hispanic, Asian American or some other race. Seventy-five percent (n = 211) were male; the mean age was 63 years (SD: 12). The mean ADI was 42 (SD: 28), indicating a low to moderate SES. Seventy percent (n = 200) had a high health literacy score, 20% (n = 57) had a medium score, and 10% (n = 27) had a low health literacy score. Only a patient’s race/ethnicity and the ADI were significantly associated with their health literacy score. Seventy-seven percent of Caucasian patients had high health literacy scores compared to 59% of African American patients and 48% patients of Hispanic, Asian or some other origin (P < .001). Patients with low health literacy had an ADI score (65.1) that was almost double the score of patients with high health literacy scores (38.5) (p < .001). Conclusions: Roughly one-third of patients seen at this urban cancer center did not have a high health literacy score. Socio-economic status was a stronger correlate to health literacy than patient age, marital status, or insurance type. EMRs should capture a patient’s SES in some manner, as this is strongly associated with health literacy.