bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparison of patients' and physicians' expectations regarding precision oncology tests.
Authors: Dehar Navdeep , Abedin Tasnima , Tang Patricia A. , Bebb D. Gwyn , Cheung Winson Y. 
Published: May 2020

1568 Background: With the increasing number and frequency of biomarker and genetic tests that are offered to patients with cancer, it is important to ensure that they fully understand the implications of these tests. In this survey study, we aimed to compare the attitudes and expectations of patients and cancer physicians about the role of biomarker and genetic testing in clinical decision-making. Methods: Two separate, complimentary, self-administered questionnaires for cancer patients and their physicians, respectively, were collected in Calgary, Alberta, Canada. Survey responses from patients were subsequently matched with those of their corresponding oncologists to form patient–oncologist dyads. We determined the concordance rates between responses of patients and those of their oncologists. Results: A total of 113 patients and 15 physicians participated in the study from July to September 2019. Patients demonstrated good understanding of general cancer biology (79%) and diagnostic processes (91%) associated with precision oncology. About 70% patients were willing to undergo minor procedures, and participate in research involving biomarker or genetic testing; however, this was over-estimated by their physicians in 82% of cases. Many patients felt that their tumor should be tested to guide treatment (70%) and were not bothered by potential delays in treatment due to testing (23%). These views from patients were largely shared by their oncologists (concordance 64%). While only 28% patients thought that they had enough knowledge to make informed decisions, majority (68%) said that they needed more information. Importantly, knowledge and expectations regarding the applications of biomarker or genetic test results on actual diagnosis and prognosis were grossly discrepant between patients and their oncologists (concordance 26% and 36%, respectively). Conclusions: Patients and cancer physicians tend to be aware of the advances in precision oncology and are willing to participate in biomarker and genetic testing and research. However, they do not consistently agree about the roles and applications of these tests, which may result in misplaced expectations. Strategies to improve education and communication are needed to align these expectations and improve the quality of clinical decision-making.
Population genetic screening for hereditary breast and ovarian cancer in at-risk patients: A novel testing and prevention model for community hospitals reveals high mutation rates rurally.
Authors: Shelton Charles Hendrix , Boehmer Leigh , Weldon Christine B. , Guenther William C. , Trosman Julia Rachel , Ruiz Antonio 
Published: May 2020

1575 Background: Genetic testing for at risk non-cancer patients continues to increase (Guo F, et al Cancer 2020). We identified a high risk of familial breast and ovarian cancer in rural eastern North Carolina, and created a systematic approach for genetic screening, counseling and testing. Methods: A family history questionnaire was designed to assess for the risk for hereditary breast and ovarian cancer (HBOC) using NCCN guidelines, and used at key intake points within the unaffected population to determine eligibility for genetic testing. First it was offered at the time of all mammograms. Second, we offered it in the primary gynecology care setting to capture younger patients not participating in screening mammography. Patients meeting HBOC criteria were sent a letter and two phone calls to schedule genetic counseling. Analysis via descriptive statistics. Results: 3000 rural women screened using our systematic approach to genetic risk assessment. 22.4% (673/3000) of female patients met NCCN criteria for HBOC panel testing. All offered consultation and counseling. With a backlog to see patients due to higher than expected accrual, 217 patients have completed pre-test genetic counseling, 201 completed local 19-gene panel test, and 201 had post-test counseling. Germline mutations (=>1) that predict for genetic susceptibility to cancer(s) occur in 7.8% of our screened and tested population. Currently 1 in 400 patients screened in our unaffected population carry a BRCA mutation, and 1 in 200 carry some pathogenic mutation that increases risk for HBOC. Conclusions: This rural model of screening and prevention of at risk patients for HBOC is successful at detecting pathogenic mutations in unaffected patients before they are diagnosed with cancer. Interestingly, the rate of positivity in the unaffected population (meeting criteria) is as high as the known breast cancer population rate of germline mutations (5-10%), validating the use of testing guidelines with our model. Discovering this susceptibility before a cancer diagnosis resulted in appropriate high risk management with prevention and risk reduction strategies. We plan to expand this model to the male screening population in 2021, and streamline genetic assessment and testing for the larger population at risk by engaging more rural primary care clinics over time to increase testing compliance. We also plan to consider broader gene panels as newer mutations become linked to HBOC. Clinical trial information: UMCIRB 19-001052.
Implementation of systematic germline genetic testing (GT) for metastatic prostate cancer (mPC) patients at the Puget Sound VA prostate oncology clinic.
Authors: Sokolova Alexandra , Miyamoto Akemi N. , Pouv Darren L. , Cheng Heather H. , Montgomery Robert B. 
Published: May 2020

1578 Background: There is increasing clinical relevance for GT in patients with mPC to evaluate the 2-fold possibilities of molecularly targeted therapies and implications for relatives. NCCN guidelines recommend GT for subsets of men, including those with mPC. While exciting, there are new logistical challenges around workflows for delivering GT services. We sought to address these challenges through a prospective pilot study designed to systematically deliver GT to all men with mPC receiving care at the Puget Sound VA prostate cancer (PUG-VA PC) Clinic. Our hypothesis was that systematic universal GT for men with mPC would identify similar prevalence rates of germline pathogenic/likely pathogenic variants (P/LPV) among veterans compared to previously reported cohorts. Methods: We conducted an IRB-approved, prospective trial testing feasibility of a systematic workflow to identify all veterans with mPC seen at PUG-VA PC Clinic between 11/2016-1/2020 to discuss and offer GT. A research coordinator pre-screened each clinic schedule to identify patients with mPC, notified the oncologist to discuss pretest education and GT with the patient at the appointment. Consenting patients provided a saliva sample same day in clinic for the CLIA-certified Color Genomics 30-gene cancer gene panel. Results were issued to patients and providers, and results were discussed by email and phone with a genetic counselor. Uptake of GT and prevalence of P/LPV was measured and compared to previously reported data from the retrospectively tested UW TAN cohort. χ2-test was performed. Results: 84% (190/227) of approached veterans with mPC consented and 80% (182/227) completed GT. 6.6% (12/182) of men were found to carry P/LPV in DNA repair genes: 3 in BRCA2, 2 in BRCA1, 4 in ATM, and 3 in CHEK2. Overall, 6.6% rate of P/LPV in DNA repair genes was comparable to the 8.8% previously reported in the UW TAN cohort (p = 0.69). Conclusions: Dedicated clinic-based strategies to offer and provide GT and services for veterans with mPC is feasible and results in high GT consent and uptake, especially with direct oncologist involvement. Proportion of consenting to proceed with GT was nearly identical to a referral-based specialty Prostate Cancer Genetics Clinic (Pouv, Sokolova, and Cheng, unpublished). The proportion of P/LPV in the PUG-VA PC population was comparable to a geographically similar retrospective cohort. Updated data, including detailed demographics and GT results, will be reported at final presentation.
Intervention combining nurse navigators (NNs) and a mobile application versus standard of care (SOC) in cancer patients (pts) treated with oral anticancer agents (OAA): Results of CapRI, a single-center, randomized phase III trial.
Authors: Mir Olivier , Ferrua Marie , Fourcade Aude , Mathivon Delphine , Duflot-Boukobza Adeline , Dumont Sarah Naomie , Baudin Eric , Delaloge Suzette , Malka David , Albiges Laurence , Pautier Patricia , Robert Caroline , Planchard David , de Botton Stéphane , Lemare François , Guillet Marilene , Puglisi Vanessa , Abbas May , Di Palma Mario , Minvielle Etienne 
Published: May 2020

2000 Background: Various interventions aiming to improve a safe use of oral anti-cancer agents have previously been reported. These retrospective studies involved nurse-led follow-up and use of health technologies. However, the potential impact of these combined strategies is limited by a lack of rigorous methodology. Methods: We performed a randomized phase 3 trial comparing an intervention combining NNs and a mobile application vs. SOC in cancer pts treated with OAA (excluding hormonal therapy) in our tertiary cancer center. Pts initiating OAA (all types of cancer, PS < 3, life expectancy > 6 months), were randomized in a 1:1 basis. The intervention combined a nursing-led follow-up and a mobile application for patients. NNs provided regular phone follow-ups to manage symptoms and assess toxicities, adherence and supportive care needs. Pts had access to a mobile application to record tracking data, contact NNs via secure messaging or a dedicated phone line. The intervention lasted 6 months. The primary endpoint was the Relative Dose Intensity (RDI). Secondary endpoints included adherence, toxicity, response and survival, quality of life, pts experience (PACIC Score), end-of-life support, and economic estimation of the use of healthcare resources. Results: From October 2016 to May 2019, 609 pts (median age: 62 years, 20-92; PS2: 11.8%) were included. 39% were receiving oral chemotherapy, and 61% other OAA. The RDI was significantly higher in the CAPRI arm (93.4% ±0.26 vs. 89.4% ±0.19, p = 0.04). The CAPRI intervention also improved PACIC scores (mean: 2.94±0.83 vs. 2.67±0.89, p = 0.01), the number of unplanned hospitalizations (15.1% vs. 22.0%, p = 0.04), hospitalization duration (mean: 2.82±6.96 days vs. 4.44±9.60, p = 0.02), and treatment-related grade≥3 toxicities (27.6% vs. 36.9%, p = 0.02). Conclusions: Compared to SOC, the CAPRI intervention improved RDI, pts experience, hospitalizations and their duration, as well as the rate of treatment-related grade≥3 toxicities. This type of intervention should represent a new standard in pts receiving OAA. Clinical trial information: NCT02828462.
Survival impact of multidisciplinary thoracic oncology care in a regional healthcare system.
Authors: Osarogiagbon Raymond U. , Faris Nicholas Ryan , Smeltzer Matthew , Derrick Anna , Lammers Philip Edward , Satpute Shailesh R. , Walsh William , Sroufe Rameses , Robbins Todd , Tokin Keith , Optican Rob , Fulford Angela , McHugh Laura , Wright Jeffrey , Mehrotra Anurag , Callihan Thomas , Ray Meredith 
Published: May 2020

2004 Background: Much-advocated, the value and impact of multidisciplinary care and planning (MDC) needs greater evidence. We compared non-small cell lung cancer (NSCLC) patient characteristics, treatment patterns and survival in a large community healthcare system spanning 3 US states with some of the highest lung cancer incidence and mortality rates. Methods: We identified MDC patients in the Tumor Registry NSCLC data from 2011-2017. Because the MDC program was located in metropolitan Memphis, we separated non-MDC patients by location of care resulting in 3 cohorts: MDC, non-MDC metropolitan care and non-MDC regional care. Using National Comprehensive Cancer Network guidelines, we categorized treatment by stage as ‘preferred’, ‘appropriate’ (allowable under certain circumstances). We compared demographic and clinical characteristics across cohorts using chi-squared tests and compared survival using Cox regression with Bonferroni adjustment. We repeated survival analysis with propensity matched cohorts. Results: Of 6259 patients, 14% received MDC, 56% metro care and 30% regional care; MDC had the highest rates of African Americans (34% v 28% v 22%), stage I-IIIB (63 v 40 v 50), urban residents (81 v 78 v 20), stage-preferred treatment rates (66 v 57 v 48), stage-appropriate treatment rates (78 v 70 v 63;), and lowest non-treatment rates (6 v 21 v 28). All p<0.001. Compared to MDC, the hazard for death was higher in metro (1.4, 95% confidence interval 1.3-1.6) and regional (1.7, 1.5-1.9); hazards were higher in regional care v metro (1.2, 1.1-1.3); all p<0.001 after adjustment. Results were similar for MDC comparisons after propensity matching with and without adjusting for preferred treatment. No differences in regional and metro cohorts. Conclusions: In this large community-based healthcare system, receipt of MDC for NSCLC was associated with significantly higher rates of guideline-concordant care and survival, providing strong evidence for recommending rigorous implementation of MDC. [Table: see text]
The BRCA founder outreach study: Initial results of a digital health model.
Authors: Morgan Kelly , Symecko Heather , Kamara Daniella , Jenkins Colby , Levin Jeffrey , Lester Jenny , Spielman Kelsey , Pace Lydia E. , Marcell Vanessa , Wildman Temima , Fesko Yuri Anthony , Heitler Jacob , Robson Mark E. , Nathanson Katherine , Tung Nadine M. , Karlan Beth Y. , Domchek Susan M. , Garber Judy Ellen , Hamilton Jada G. , Offit Kenneth 
Published: May 2020

2007 Background: NCCN now endorses BRCA founder mutation genetic testing (GT) via longitudinal studies in all Ashkenazi Jewish (AJ) individuals. The BRCA Founder OutReach (BFOR) study offers pre-GT online education with posttest engagement of primary care providers (PCPs). Methods: The study in 4 US cities enrolls those age > 25 with > 1 AJ grandparent. Participants enroll online with chatbot and video education, have GT at local centers, receive results from their PCP or BFOR staff, and are surveyed 12 weeks post disclosure and annually for 5 years. Univariate analyses and multivariable (MV) logistic regression models were used to evaluate characteristics associated with not completing GT, selecting PCP to disclose GT, and positive GT. Results: As of January 2020, 4754 participants consented (77.5% female, median age 51); 37.7% never previously considered GT. Cancer family histories (FHx) were 56.4% low risk (LR), 36.4% high risk (HR), and 7.2% had a familial mutation (FM). To date, 3658 participants (76.9%) completed and 677 (14.2%) did not complete GT; the remainder are pending. Only 34.8% of participants selected PCP to disclose GT, and 42.6% of PCPs agreed. Of the 124 mutation carriers (3.4%) identified, 60.5% had a FM. At the 12-week survey, 65.4% of mutation carriers planned to proceed with recommended screening or scheduled risk reducing surgery; 3.5% of those with negative GT and HR FHx reported further GT. Satisfaction was high (mean 9.58/10, SD 1.12) and unrelated to result (p>.05). Conclusions: A digital model for founder mutation testing engaged those with LR FHx and no prior experience with GT. Older participants were more likely to complete the study. Males were less likely to enroll but more likely to carry mutations. The majority of those who tested positive had a FM. A minority of results were disclosed by PCPs. Continued follow up is needed to determine long term outcomes. [Table: see text]
Randomized trial of web-based genetic education versus usual care in advanced cancer patients undergoing tumor genetic testing: Results from the ECOG-ACRIN NCI Community Oncology Research Program (NCORP; EAQ152) COMET trial.
Authors: Bradbury Angela R. , Lee Ju-Whei , Gaieski Jill B , Li Shuli , Gareen Ilana F , Flaherty Keith , Herman Benjamin A. , DeMichele Angela , Domchek Susan M. , Maxwell Kara Noelle , Onitilo Adedayo A. , Virani Shamsuddin , Park Sujung , Faller Bryan A. , Grant Stefan C. , Ramaekers Ryan C. , Behrens Robert J. , Nambudiri Gopakumar S. , Carlos Ruth , Wagner Lynne I. 
Published: May 2020

2008 Background: Enthusiasm for precision oncology may obscure the complex psychosocial and ethical considerations for tumor genetic testing. Low patient genetic knowledge has been documented and heightens the risk for adverse experiences. We developed a web-based intervention to increase genetic knowledge and decrease distress among advanced cancer patients undergoing tumor genetic testing. Methods: 594 patients (80% from NCORP Community Sites) were recruited and randomized to web-intervention (n = 293) or usual care (n = 301), prior to receipt of tumor genetic test results. Primary outcomes were genetic knowledge, anxiety, depression, and cancer-specific distress measured at T0 (prior to intervention), T1 (post-intervention), T2 (after receipt of tumor results) and T3 (3 months post receipt of tumor results). Secondary outcomes included satisfaction, regret and disappointment. The effect of web-intervention was evaluated using t-test, multiple linear regression and logistic regression, with an intent-to-treat approach. Results: Patients randomized to web-intervention had better knowledge improvement than those randomized to usual care (T1-T0, p < 0.0001; T2-T0, p = 0.003). No difference was observed in change scores for anxiety, depression or cancer-specific distress. To find the moderators of intervention effect (including sex, age, education, and literacy) two 2-way interactions were noted with statistical significance: higher depression among those in the intervention arm versus the control arm for patients with lower literacy (p = 0.03); and lower cancer-specific distress among women in the intervention arm than with usual care but no such effect noted in men (p = 0.01). 71% of patients reported receiving tumor test results and this did not differ by arm. Only 20% of patients reported regret and disappointment at T2, which was more likely for those without a mutation of interest (MOI) detected vs those with a MOI detected (OR = 2.08, 95% CI, 1.13 to 3.83, p = 0.02). Conclusions: Web-based education prior to receipt of tumor genetic test results increases patient understanding of tumor genetic testing. While the intervention did not significantly reduce distress, results suggest that women who received the intervention had lower cancer-specific distress than those with usual care. Future refinements to the web-intervention are needed to address low literacy groups, men and patients with no actionable results. Clinical trial information: NCT02823652.
Patient-reported care satisfaction and symptom burden in hospitalized patients with cancer.
Authors: Kaslow-Zieve Emilia R. , Qian Carolyn L. , Azoba Chinenye C. , Wang Irene , Van Seventer Emily E. , Newcomb Richard , Jackson Vicki A. , Ryan David P. , Greer Joseph A. , El-Jawahri Areej , Temel Jennifer S. , Nipp Ryan David 
Published: May 2020

2013 Background: Hospitalized patients with cancer often experience high symptom burden, which may impact their care satisfaction and use of health care services. Yet, studies describing these patients’ care satisfaction, symptom burden, and health care utilization are lacking. Methods: We prospectively enrolled patients with cancer and unplanned hospitalizations from 9/2014-4/2017. Upon admission, patients self-reported their care satisfaction (FAMCARE items asking about satisfaction regarding speed with which symptoms are treated and coordination of care) and physical (Edmonton Symptom Assessment System [ESAS]) and psychological (Patient Health Questionnaire 4 [PHQ4]) symptom burden. We used regression models to identify patient factors associated with care satisfaction. We also explored associations between patients’ care satisfaction, symptom burden, and hospital length of stay (LOS) in models adjusted for age, sex, marital status, comorbidity score, cancer type, cancer documented as curable/incurable, time since cancer diagnosis, and admission to a dedicated oncology service. Results: We enrolled 1,576 of 1,749 (90.1%) consecutive patients (mean age = 63.19±13.39 years, 46.3% female). Most reported being very satisfied/satisfied with the speed with which symptoms are treated (89.0%) and coordination of care (90.1%). Older age (B = 0.01, P < .02 for both) and admission to a dedicated oncology service (B = 0.20, P < .01 for both) were each independently associated with higher satisfaction with the speed with which symptoms are treated and coordination of care. Higher satisfaction with the speed with which symptoms are treated was associated with lower PHQ4 depression (B = -0.14, P = .01), PHQ4 anxiety (B = -0.11, P < .01), ESAS physical (B = -1.30, P < .01), and ESAS total (B = -2.44, P < .01) symptoms. Higher satisfaction with coordination of care was associated with lower PHQ4 depression (B = -0.14, P = .02), PHQ4 anxiety (B = -0.16, P < .01), ESAS physical (B = -1.30, P < .01), and ESAS total (B = -2.75, P < .01) symptoms. Satisfaction with the speed with which symptoms are treated (B = -0.47, P = .03) and coordination of care (B = -0.50, P = .03) were both associated with shorter hospital LOS. Conclusions: Most hospitalized patients with cancer reported high care satisfaction, which was associated with older age and admission to a dedicated oncology service. We found relationships among higher care satisfaction, lower symptom burden, and shorter hospital LOS, underscoring the importance of efforts to enhance symptom management and care coordination in this population.
Cancer diagnoses and survival rise as 65-year-olds become Medicare eligible.
Authors: Patel Deven C. , He Hao , Berry Mark F. , Yang Chi-Fu Jeffrey , Trope Winston , Lui Natalie , Liou Douglas Z. , Backhus Leah Monique , Shrager Joseph B 
Published: May 2020

2015 Background: A “Medicare effect” has been described to account for increased health care utilization occurring at the age of 65, when individuals become eligible for government-sponsored health care. The existence of such an effect in cancer care, where it would be most likely to reduce mortality, has been unclear. Methods: Patients aged 61-69 diagnosed with lung, breast, colon, or prostate cancer from 2004-2016 were identified using the Surveillance, Epidemiology, and End Results database and dichotomized based on eligibility for Medicare (age 61-64 vs 65-69). Using age-over-age percent change calculations, trends in cancer diagnosis, AJCC staging, and survival were characterized. Results: 134,991 patients were identified with lung cancer; 175,558 with breast; 62,721 with colon; and 238,823 with prostate. The age-over-age growth in the number of cancer diagnoses was highest at age 65 when compared to all other ages within the decade, for all four cancers (Table: p<0.01, p<0.001, p<0.01, p<0.001 respectively). Comparing age 65 diagnoses to the 61-64 year old cohort, the greatest difference for all four cancers was seen in stage I (lung p<0.001; breast p<0.002; colon p<0.001; prostate p<0.02). The older (65-69), Medicare-eligible cohort had higher cancer specific 5-year survival than the 61-64 aged cohort for lung (22.0% vs 21.0%, p<0.01) and colon cancer (66.2% vs 63.2%, p<0.01). Conclusions: The 65 age threshold for Medicare eligibility is associated with more cancer diagnoses, particularly in stage I, resulting in improved cancer-specific survival for some cancers. Near-elderly individuals may be delaying care until the age of 65. A Medicare-for-all system would thus be likely to reduce cancer mortality. [Table: see text]