bluuebunny/crossref_metadata_2025_split huggingface dataset:
Financial conflicts of interest among the National Comprehensive Cancer Network (NCCN) Clinical Practice Guideline (CPG) Panelists in 2019.
Authors: Desai Aakash , Chengappa Madhuri , Go Ronald S. , Poonacha Thejaswi 
Published: October 2019

15 Background: CPG are evidence-based guidelines, which serve as a standard of care in practice, quality improvement, and reimbursement. The extent of financial conflicts of Interest (FCOI) in NCCN guidelines has not been recently evaluated. Our study evaluated the extent of FCOI in the NCCN CPG among the 10 most common malignancies in the US. Methods: We examined the latest 2019 version of the NCCN CPG for the 10 most common cancers by incidence in the US. Using disclosure lists, we catalogued the FCOIs for the panelists under various categories outlined in the CPG. We also tabulated the companies/institutions involved in each disclosure. An “episode” describes 1 instance of participation of a panelist in 1 company in 1 category of each guideline. “Affiliation” describes a commercial, industry, or institute affiliation reported by a panelist in each episode. Results: Of the 491 panelists on the CPG, 483 (98.3%) completed FCOI disclosures. 224 (46.38%) reported at least 1 FCOI. A total of 1,103 episodes were disclosed with an average of 4.9 episodes per panelist with FCOI. Being a part of scientific advisory boards, consultant, or expert witness was the most common FCOI category (19.9%). A total of 191 companies were associated with 1,103 episodes of FCOI. The top companies were Bristol Myers Squibb, Merck, Genentech and AstraZeneca. Among the top 10 cancers, the prevalence of FCOI were lung (56%), bladder (52%), pancreatic (52%), non-Hodgkin lymphoma (50%), kidney (49%), colorectal (43%), breast (42%), melanoma (40%), prostate (38%), and uterine (32%). Among the panelists with FCOI, 26%, 17%, and 57% reported 1, 2, and > 3 episodes, respectively. There were 127 episodes among the CPG chairs/vice chairs who reported FCOI (mean 6.4). The chairs/vice chairs of uterine, pancreatic, melanoma, and prostate cancer CPG did not have any FCOI. Conclusions: FCOI are very prevalent among the top 10 NCCN CPG panelists. In almost half of the CPG, the majority of the panelists had at least 1 FCOI. Over half of the CPG chairs/vice chairs reported multiple FCOI. Further studies are necessary to determine the impact of these FCOI.
Employer provided health benefits among cancer survivors in the United States.
Authors: Zheng Zhiyuan , Han Xuesong , Banegas Matthew P. , Zhao Jingxuan , Rai Ashish , Tucker-Seeley Reginald , Jemal Ahmedin , Yabroff K Robin 
Published: October 2019

155 Background: Nearly 40% of cancer survivors are of working age in the U.S. Access to high quality diagnosis, treatment, and survivorship care requires both health insurance coverage and sick leave, key components of employer health benefits. This study examines work limitations, paid sick leave, and employer offered health insurance among cancer survivors. Methods: We used the National Health Interview Survey (2001-2017) to identify cancer survivors aged 18-64 years. Work limitations were asked among all cancer survivors regardless of work status (n = 15,247), and categorized into unable to work, limited in type/amount of work, and not limited at all. Paid sick leave and employer offered health insurance offered were asked of cancer survivors who were working in the last week (n = 8741). We used generalized ordinal logistic regressions to examine work limitation and employer health benefits among cancer survivors, controlling for demographic characteristics, time since cancer diagnosis, number of cancer diagnoses, income, and comorbidities. Stratified analyses by type of workplace (private sector, federal/state/local government, and self-employed), and hours worked per week (full time with 35+ hours per week vs part time < 35 hours per week) was conducted. Results: Among cancer survivors aged 18-64 years, 10.7% and 5.3% reported unable to work at all and limited in types/amounts of work, respectively; 57.7% and 67.6% of those working in the last week received paid sick leave and employer offered health insurance, respectively. In stratified analyses, government jobs were associated with the highest paid sick leave and employer insurance (85.7% and 85.6%, respectively), followed by private sector (58.3% and 70.7%, respectively), and self-employed (8.3% and 15.7%), respectively. Moreover, full time jobs had higher paid sick leave (65.2% and 21.9%, respectively) and employer insurance (75.7% and 29.1%, respectively) then part time jobs. Conclusions: Cancer survivors experience work limitations and many working cancer survivors do not receive paid sick leave or health insurance from their employers. Evaluation of the effects of employer-based health benefits on survivorship care and outcomes will be important for future research.
Building international partnerships to improve global oncological care: Perspective from Rutgers-CINJ Global Oncology Fellowship Program.
Authors: Chandar Ashwin , Kaur Sukhdeep , Ralefala Tlotlo Bathethi , Toppmeyer Deborah , Philipp Claire , Marlink Richard , Antony Reena , DiGiacobbe Marilyn , Lebelonyane Refeletswe , Gaolathe Tendani , Mayer Tina M. 
Published: October 2019

159 Background: With cancer accounting for 1 in every 7 deaths worldwide and 60-70% of cancer deaths occurring in low- and middle-income countries, any advancement in cancer care should include understanding to alleviate structural inequalities that produce these global oncological disparities. Rutgers-Cancer Institute of New Jersey (R-CINJ) Oncology Fellowship program, through partnerships with Rutgers Global Health and University of Botswana (UB), established a global oncology program in 2018 to provide young oncologists in training with this educational opportunity. Aims included understanding challenges faced by cancer patients in Botswana, evaluating opportunities to improve oncology care at Princess Marina Hospital (PMH), scholarly collaborations, and exchange knowledge. Methods: In partnership with PMH, UB, and Ministry of Health and Wellness (MOHW), R-CINJ created a global oncology program consisting of a 1 month rotation at PMH in Gaborone, Botswana, as well as longitudinal research/quality improvement (QI) projects. Two 3rd year oncology fellows rotated with house officers and oncologist at PMH. Weekly video conferences facilitated communication during the elective. Projects continued throughout 3rd year of fellowship, in conjunction with programmatic meetings. Results: Fellows gained exposure to cancer care using limited resources. In working with PMH staff, mentorship was provided, QI ideas were shared, and organizational changes were implemented. Scholarly activity was undertaken to examine trends in chemotherapy utilization at PMH over a 12-month period to assess patterns of malignancy and issues with stock outs. Relationship between pathology at PMH, UB, and Rutgers-CINJ and Rutgers Biomedical Engineering was established to expand digital pathology services in Botswana. Conclusions: Our global oncology program is a successful start to an ongoing partnership to help improve cancer care in Botswana. Future directions include development of cancer protocols in Botswana, helping limit medication shortages, and establishing telemedicine based collaboration to assist with diagnosis and improve pathology turnaround time.
Disparities in receipt of guideline concordant treatment for early-stage non-small cell lung cancer (NSCLC) patients in California.
Authors: Obrochta Chelsea A , Murphy James Don , Nara Atsushi , Thompson Caroline A. 
Published: October 2019

160 Background: Lung cancer is the second most commonly diagnosed cancer and the leading cause of cancer-related death in the U.S. In 2013, the U.S. Preventive Services Task Force began recommending lung cancer screening, which has resulted in earlier stage diagnosis for many tobacco users. The National Comprehensive Cancer Network (NCCN) provides evidence-based cancer treatment recommendations. Evidence suggests that a patient’s receipt of guideline-concordant treatment (GCT) increases survival, especially for screen-detected, earlier stage cancers. The objective of this study is to describe nonadherence to GCT and treatment delay in California NSCLC patients by sociodemographic characteristics and geography. Methods: 53,746 patients diagnosed with stage I/II NSCLC (2000-2015) in the California Cancer Registry were included in our study. We classified GCT according to NCCN guidelines and treatment delay as >60 days after diagnosis. We report proportion of nonadherence to GCT and treatment delay overall, in 5-year periods and by patient race/ethnicity, socioeconomic status, payer, and marital status. Hotspot analysis is underway to identify regions at increased risk for nonadherence to GCT and treatment delay by patient residential census tract. Results: Overall, 55.9% of patients received GCT, 14.1% of patients received no treatment, and nonadherence to GCT increased over time. Among those who received treatment, 26.7% experienced a treatment delay. Nonadherence to GCT and delay was more frequent in patients who were black or Hispanic, unmarried, had public insurance, and were of lower socioeconomic status. Based on preliminary analyses, we expect nonadherence to GCT and treatment delay to be non-uniformly distributed across California neighborhoods. Conclusions: Nonadherence to GCT and treatment delay disproportionately affect priority populations. With rising numbers of early stage lung cancers due to screening smokers, administration of timely proper treatment of lung cancer is critical.
Comparing nonconscious nonverbal synchrony in racially concordant and racially discordant oncology interactions.
Authors: Hamel Lauren M. , Moulder Robert , Eggly Susan , Albrecht Terrance Lynn , Boker Steven , Dougherty David W. , Penner Louis 
Published: October 2019

169 Background: Communication in racially discordant (Black patient, non-Black physician) oncology interactions, which constitute about 80% of Black patients’ interactions, is generally poorer than in racially concordant interactions, and likely contributes to treatment disparities. However, the nonverbal behaviors that contribute to this problem are largely unknown. We examined nonverbal synchrony, or the nonconscious coordination of movement, which can reflect relationship quality. We hypothesized that racially discordant interactions will have lower levels of nonverbal synchrony. Methods: Data include video recordings of 68 Black patients and 163 White patients discussing treatment with their non-Black oncologists. Recordings were submitted to motion detection software to measure nonverbal synchrony. This software measures global synchrony (all correlated motion), peak synchrony (all positively correlated motion), who is leading the interaction (similar to who is leading in ballroom dancing), and how much synchrony occurs based on who is leading the interaction. Using multi-level models, we investigated whether nonverbal synchrony differed in racially concordant and racially discordant dyads. Results: Findings showed greater levels of global synchrony (p < .05) and greater peak synchrony (p < .05) in racially discordant interactions compared to racially concordant interactions. Global synchrony was the same in racially concordant interactions regardless of who was leading, but greater global synchrony occurred in racially discordant interactions when the patient was leading (p < .05). Conclusions: This is the first study to use a dynamic jointly determined measure of behavior to assess oncology interactions. Contrary to our hypothesis, nonverbal synchrony was greater in racially discordant interactions than in racially concordant interactions. Patients are driving more of the synchrony in racially discordant interactions. This may suggest that patients in racially discordant interactions adapt to their physicians to bridge racial differences. Findings could contribute to physician training to enhance coordination and outcomes in oncology interactions.
Real-world practice patterns of providers managing older patients with non-small cell lung cancer.
Authors: Das Devika Govind , Bhatia Avnish K , Wujcik Debra , Owenby Susie , Hall Wanda D. , Smith Tasha , Zinner Ralph 
Published: October 2019

17 Background: Most patients with non-small cell lung cancer (NSCLC) have advanced disease at diagnosis and are older with median age 72 years. Evidence-based treatment (EBT) selection requires availability of molecular testing (MT) results at time of treatment decision and geriatric assessment (GA) helps determine a patient’s ability to tolerate therapy. This study describes practice patterns and evidence based treatment selections of providers managing older patients with NSCLC. Methods: After provider education and using care planning software (CPS), 50 patients with advanced NSCLC from two academic centers completed surveys regarding treatment goals and decision-making preferences, and patients ≥ 65 completed a modified GA that included activities of daily living and comorbidity assessment. Once treatment was selected, a personalized care plan was generated. Comparison treatment data from 17 community patients was obtained. Results: Participants were mean age 65, 52% female, and 78% white. Of 28 stage IV patients, 79% had MT and results available at time of treatment decision, and 100% met EBT guidelines. The community cohort had 47% testing, 29% results available, and 65% met guidelines. GA results in 24 patients were 46% frail, 29% intermediate fit, and 25% fit. Two patients (8%) were frail and had a plan change due to GA results. Conclusions: Obtaining timely MT results remains challenging. Continued strategies to ensure MT and timely results should be explored, including quality assurance monitoring given the increasing importance of MT in treatment selection. GA was less impactful in this setting, likely due to later stage patients, presumed frailty, and treatment goal being palliation. We believe GA would have greater impact in early stage NSCLC where aggressive treatments are offered with curative intent.
Comparison of attitudes and beliefs about cancer clinical trial enrollment between physicians, research staff, and cancer patients.
Authors: Hillyer Grace , Beauchemin Melissa , Hershman Dawn L. , Kelsen Moshe A. , Brogan Frances L , Sandoval Rossy , Schmitt Karen M. , Reyes Andria , Terry Mary Beth , Lassman Andrew B. , Schwartz Gary K. 
Published: October 2019

170 Background: Essential to bringing innovative cancer treatments to patients is voluntary participation in clinical trials but fewer than 10% of cancer patients are enrolled onto a trial. We used a domain-oriented framework to assess barriers to cancer clinical trial enrollment (CTE). Methods: Physicians and research staff completed an online survey in 2017; adult cancer patients not currently enrolled in a trial were interviewed in 2018. Perceived structural, provider- and patient-level barriers to CTE were assessed. Differences in perceptions, attitudes and beliefs toward CTE between physicians and staff, patients by ethnicity, and physicians/staff and patients were examined. Results: In total, 120 physician/staff (64.4% response rate) and 150 cancer patient completed surveys. Interacting with the patients’ family was seen as a CTE barrier by nearly one-third of physicians/staff overall, however, staff much more often stated this barrier than did physicians (44.0% vs. 18.2%, p= 0.007). Hispanic patients more often stated they would join a trial, even if standard therapy was an option compared to non-Hispanic patients ( p= 0.004). Overall, patients, more often than physicians/staff, believed that clinical trials are only offered to people whose disease is hopeless (27.3% vs. 8.7%, p < 0.001) and that CTE does not help patients personally (32.9% vs. 1.8%, p < 0.001). More often physicians/staff believed that patients decline CTE due to language or cultural barriers (57.5% vs. 27.3%, p < 0.001), lack of understanding about clinical trials (63.3% vs. 9.1%, p = 0.001), and mistrust of the medical system (69.2% vs. 36.4%, p= 0.043) than was reported by patients. Patients less often reported declining CTE because of concerns about invasive procedures (9.1% vs. 41.7%, p = 0.02), toxicity (18.2% vs. 60.0%, p= 0.006) or reluctance to be randomized/receive a placebo (27.3% vs. 70.8%, p= 0.005). Conclusions: Our findings indicate a wide gap between provider and patient attitudes and beliefs about CTE. Reconciling these differences will require tailored education to dispel misperceptions and strategies to improve the quality of patient-provider communication.
Patient and provider perceptions of emergency room visits during chemotherapy.
Authors: Panattoni Laura Elizabeth , Jones Salene M.W. , Bolt Kaylin J. , Kreizenbeck Karma L. , Ittes Annika , Ramsey Scott David 
Published: October 2019

183 Background: Emergency room (ER) visits during chemotherapy are costly. To identify potential causes of ER visits, we interviewed oncology patients and providers about symptoms and other factors related to ER visits. Methods: People with cancer (n = 19) and oncology physicians and nurses (n = 11) were interviewed using a semi-structured protocol. Interviews were transcribed. The study team developed a codebook and interviews were coded deductively. Four of the interviews were double coded. Results: Patients reported communicating with their physicians mostly by telephone. Patients reported a variety of distressing symptoms from chemotherapy including infection, mouth sores, distress, fatigue, neuropathy, gastrointestinal (GI) effects. Pain, fever, neuropathy, and dizziness were symptoms that motivated ER visits. Patients reported that contact with their care team and having a specific plan for symptoms helped prevent ER visits. Patients also reported that going through chemotherapy the first time was harder because they did not know what to expect and the patient education can be overwhelming. Providers did not always have formal protocols for proactively contacting patients but those that did contacted patients early in treatment. Providers reported GI symptoms, pain, shortness of breath, dizziness, and infection as causes of ER visits. They reported difficulties assessing symptoms due to reporting inaccuracies and reticence to share details. Providers cited financial insecurity, remote living, and lack of social support as factors increasing risk of ER visits. Providers reported some patients would not call frequently enough while a smaller subset called more frequently than providers perceived as needed. Conclusions: Results suggest contact with the care team is crucial for preventing ER visits during chemotherapy. Symptoms causing ER visits were consistent with previous literature
Examining patient and visit characteristics associated with the cancer patient experience.
Authors: Bridge Erica , Singh Simron , Murdoch Amanda , Mozuraitis Mindaugas , Nicholls Brett , Moody Lesley 
Published: October 2019

204 Background: Your Voice Matters (YVM) is a 28-item patient experience survey for adult cancer outpatients undergoing treatment in Ontario.The purpose was to examine patient and visit characteristics associated with YVM responses. Methods: YVM was administered to eligible patients (n=8,704) at 14 centres in 2017.Respondents answered items on a five-point Likert scale (4 or 5 = positive response). A multivariable logistic regression (MLR) was undertaken for each YVM item.Variables (reference group) included: disease site (heamatology), age group (65+), sex (female), rurality (urban), last visit type (consult), income quintile(highest) and immigration tercile (lowest). Significant results ( p<.05) vary by MLR model. Therefore a p-value range is provided for all significant variables for all MLR models. Results: Patients were more likely to have a less positive experience if they had central nervous system ( p =.000-.013), gastrointestinal ( p =.004-.026), head and neck ( p =.002-.025), or lung cancer ( p =.017-.049); were between the ages of 18-39 years ( p = <.0001-.048); were female ( p =.0001-.022); received chemotherapy( p =.0001-.047); lived in a rural location ( p =.042); from a mid-( p =.027-.045) and mid-high income quartile ( p =.021); and in the high- ( p =.002-.043) and middle-immigrant terciles ( p =.028-.047), when compared to the reference group. Patient were more likely to have a more positive experience if they had skin cancer ( p =.004-.032); were between the ages of 40-64 years ( p =.003-.033); receiving radiation ( p =.0001-.041) or a minor procedure ( p =.015); and were from the mid-low ( p =.003-.042) and low income quartile ( p =.001-.032), when compared to the reference group. Conclusions: The cancer patient experience varies by patient and visit characteristics. Future initiatives should examine these characteristics to better understand their populations to create a more tailored approaches to cancer care.
Feasibility of collecting survey-based patient-reported outcome measures (PROMs) from patients living with advanced cancer: Emerging findings from the Living with Colorectal Cancer study.
Authors: Kerba Marc , Kassam Shireen , Beaumont Crystal , Biondo Patricia , Earp Madalene , Tang Patricia A. , Simon Jessica , Watanabe Sharon , Sinnarajah Aynharan 
Published: October 2019

207 Background: The “Living with Colorectal Cancer study” seeks to characterize the experiences of patients diagnosed with advanced colorectal cancer to inform care improvements. Here we describe our experiences recruiting patients and collecting patient reported outcome measures (PROMs). Methods: Eligible patients were identified by oncologists in Alberta, Canada’s two tertiary cancer centres and approached for consent to participate during routine appointments. Following baseline surveys, participants were given a choice of completing monthly surveys via email, phone, post, or in person. We purposively chose previously validated surveys already in use provincially, including EQ-5D-5L and Putting Patients First. We endeavoured to include non-English speaking participants by providing translated study materials and interpretation. Results: In one year of recruitment, 88 patients were enrolled. Edmonton, Alberta’s patient recruitment (N = 62) is double that of Calgary, Alberta (N = 26), despite similar population sizes. In Calgary and Edmonton, 81% and 56% of participants chose email-based PROMs surveys, respectively. The current missing survey rate is 12% (i.e. surveys not completed per month). Forty-eight participants (55%) completed ≥6 sets of monthly PROMs data; 26 (30%) transferred “off study” (61% of which died). Several participants expressed the desire to describe their experiences beyond what the surveys could accommodate. Despite language accommodation, all participants chose to complete surveys in English; however, 21% reported speaking another language daily. Conclusions: It is challenging but possible to engage and retain patients with advanced cancer in research focused on PROMs. Speaking with patients face-to-face in cancer clinics increased the burden on healthcare providers (i.e. clinic flow and time spent with patients), but appears to be a practical and appropriate way to recruit participants. Offering multiple methods of communication allowed patients to participate in a manner most practical for their lifestyle and did not impact PROMs collection. Clinical trial information: NCT03572101.