bluuebunny/crossref_metadata_2025_split huggingface dataset:
The potential impact of the Deep South Network for Cancer Control on cervical cancer mortality among black females in historically underserved areas of Alabama.
Authors: Singh Karan P. , Jackson Bradford E , Ojha Rohit P , Wang Chenguang , Uhm Minyong , Fouad Mona , Partridge Edward , Bae Sejong 
Published: March 2020

6559 Background: Racial disparities in cervical cancer mortality are well-documented. The Deep South Network for Cancer Control (DSNCC) was implemented in 2000 to address this disparity by targeting blacks for cervical cancer screening in historically underserved areas of Alabama and Mississippi. We aimed to assess whether the implementation of the DSNCC has improved cervical cancer mortality among black females in Alabama. Methods: We used data from the University of Alabama-Birmingham (UAB) Comprehensive Cancer Center Tumor Registry, which comprises all cancer cases treated in the UAB Health system. We selected all black females diagnosed with cervical cancer in the pre-DSNCC (January 1995-December 1999) and post-DSNCC (January 2001-December 2005) periods. Person time was calculated for up to five years post diagnosis. We estimated hazard ratios (HRs) and corresponding 95% confidence limits (CLs) using Cox proportional hazards models. The cervical cancer mortality rate of black females who resided in DSNCC-targeted Alabama counties was compared to non-DSNCC-targeted Alabama counties before and after implementation of the DSNCC. Results: The study population comprised 129 black females diagnosed with cervical cancer pre-DSNCC and 175 diagnosed post-DSNCC. During the pre-intervention period, black females in DSNCC-targeted counties had a two-fold higher cervical cancer mortality rate than black females in non-DSNCC-targeted counties (HR=2.0; 95%CL: 1.10, 3.72). During the post-intervention period, black females in DSNCC-targeted counties had nearly a two-fold lower cervical cancer mortality rate than black females in non-DSNCC-targeted counties (HR=0.54; 95%CL: 0.35, 0.87). Conclusions: Our results suggest that the DSNCC interventions are improving cervical cancer outcomes among black females in historically underserved areas of Alabama. The current analysis was only able to examine the initial 5 years after implementation of the DSNCC; continued assessment of outcomes would be useful for assessing the long-term impact of the DSNCC.
Racial differences in attitudes toward molecular testing for personalized cancer therapy.
Authors: Yusuf Rafeek Adeyemi , Rogith Deevakar , Hovick Shelly Renee Anstey , Peterson Susan K. , Burton-Chase Allison Michelle , Fellman Bryan , Li Yisheng , Urbauer Diana L , McKinney Carolyn , Bernstam Elmer Victor , Meric-Bernstam Funda 
Published: March 2020

6566 Background: We assessed attitudes of breast cancer patients regarding molecular testing for personalized therapy and research. Methods: Female breast cancer patients presenting to a cancer center completed a questionnaire. Associations between demographic, clinical variables and attitudes towards molecular testing were evaluated. Results: 308 patients were approached and 100 completed the survey (32% response rate). If covered by insurance, most patients were willing to undergo molecular testing to assist in selection of both approved drugs (81%) and experimental therapy (59%). Even of testing was covered, non-white patients were less willing to undergo molecular testing for selection of approved drugs (nonwhites vs. whites, OR=0.13; p=0.0004) or experimental drugs (OR=0.26; p=0.0072; see table below). Most patients (75%) were willing to undergo a biopsy to guide therapy, and 46% were willing to undergo research biopsies. Non-white patients were less willing to undergo research biopsies (OR=0.17; p=0.0033). Patients desired return of research results when results had implications for treatment (91%), new cancer risk (90%), and other preventable/treatable diseases (87%). Conclusions: Most patients are willing to undergo molecular testing and minimally invasive procedures to guide approved or experimental therapy. There are significant differences in attitudes towards molecular testing between racial groups. Novel approaches may be needed to prevent disparities in delivery of genomically-informed care and to increase minority participation in biomarker-driven trials. [Table: see text]
Social inequality in survival after lung cancer: The attribution of stage at diagnosis, receipt of treatment, and comorbidity in a Danish nationwide clinical database study.
Authors: Dalton Susanne O. , Steding-Jessen Marianne , Jakobsen Erik , Schuz Joachim , Johansen Christoffer 
Published: March 2020

6570 Background: Survival after lung cancer depends on stage, treatment, and patient-specific factors as comorbidity. These factors are potentially influenced by social position (SEP). We previously reported a lower risk for advanced-stage lung cancer among persons with higher SEP and we investigate the association between SEP (education, income and cohabiting status) on receipt of 1stline treatment and overall survival in a population-based cohort of lung cancer patients in Denmark. Methods: This registry-based cohort study links data on prognostic factors and treatment from the Danish Lung Cancer Registry to individual socioeconomic information in Statistics Denmark and comorbidity from the National Hospital Discharge Registry for 13,659 persons diagnosed with lung cancer 2004-2011. Results: ORs for receipt of 1stline treatment were higher with longer education and higher income and for patients living with a partner in both men and women with low (T1-3N0M0; T0-3N1M0) and advanced-stage (T0-3N2-3M0; T4N0-3M0; TxNxM1) lung cancer although not statistically significant for all estimates. Among low-stage patients all-cause mortality was 15% higher in patients with short vs higher education, 26% higher for low vs high income and 23% higher for living alone vs living with a partner. In advanced-stage patients, differences in all-cause mortality was 11%, 14% and 8% for education, income and cohabitation status. Stage, treatment, Charlson Comorbidity Score and Performance Score attenuated associations but did not eliminate the association between low income (HR, 1.12; 95% CI, 1.05-1.19) and living alone (HR, 1.15; 95 CI, 1.06-1.25) in low stage lung cancer patients while no social differences in adjusted HR remained in advanced-stage patients. Conclusions: We show that even in a country with free and equal access to health care disparities exist in access to lung cancer treatment both of curative and of palliative intent. Differences in stage, treatment and presence of comorbidity by social position explained most of the social inequality in lung cancer survival although differences remained in the short term for low-stage patients.
Caregiver evaluation of the quality of end-of-life care (CEQUEL) scale: The caregiver’s perception of patient care near death.
Authors: Higgins Philip C , Prigerson Holly Gwen 
Published: March 2020

6573 Background: End-of-life (EOL) measures are limited in capturing caregiver assessment of the quality of EOL care. None include caregiver perception of patient suffering and prolongation of death. We developed and validated the Caregiver Evaluation of Quality of End-of-Life Care (CEQUEL) scale, a more comprehensive measure of caregiver-perceived quality of EOL care. Methods: Data were derived from Coping with Cancer (CwC), a multisite, prospective, longitudinal study of advanced cancer patients and their caregivers (N=275 dyads). Caregivers were assessed before and after patient deaths. CEQUEL’s factor structure was examined; reliability was evaluated using Cronbach’s α, and convergent validity by the strength of associations between CEQUEL scores and key EOL outcomes. Results: Factor analysis revealed four distinct factors: Prolongation of Death, Perceived Suffering, Shared Decision-Making, and Preparation for the Death. Each item loaded strongly on only a single factor. The 13-item CEQUEL and its subscales showed moderate to acceptable Cronbach’s α (range: 0.52-0.78). 53% of caregivers reported patients suffering more than expected. Higher CEQUEL scores were positively associated with therapeutic alliance (r=.13; p≤.05) and hospice enrollment (z=-2.09; p≤.05), and negatively associated with bereaved caregiver regret (r=-.36, p≤.001) and trauma symptoms (z=-2.06; p≤.05). Conclusions: CEQUEL is a brief, valid measure of quality of EOL care from the caregiver’s perspective. It is the first scale to include perceived suffering and prolongation of death. If validated in future work, it may prove a useful quality indicator for the delivery of EOL care and a risk indicator for poor bereavement adjustment.
Assessment of the effectiveness of a chemotherapy education program: A Brown University Oncology Research Group study.
Authors: Connell Nathan Theodore , Sikov William M. , Faricy-Anderson Katherine E. , Korber Susan , Thomas Anthony George , Rosati Kayla , Safran Howard , Mega Anthony E. 
Published: March 2020

6574 Background: Patients about to begin chemotherapy often have questions about their treatment along with significant anxiety. This study evaluated whether pre-chemotherapy teaching sessions improved patient knowledge and anxiety. Methods: After meeting with their oncologist to discuss planned chemotherapy treatment, subjects completed a 10-question survey which assessed their knowledge of anticipated side effects and treatment schedule on a 1-4 rating scale (1=no knowledge, 2=minimally informed, 3=reasonably informed, 4=well informed) as well as anxiety about initiating chemotherapy (1=no anxiety, 2=minimal anxiety, 3=moderate anxiety, 4=severe anxiety). Subjects then completed a structured nurse-led chemotherapy education session. The survey was repeated on the first day of cycle 1. Mantel-Haentzel Chi-square tests were used to evaluate for changes across the surveys. Subgroup analysis by Wilcoxon signed-rank test was performed to assess differences in anxiety based on age. Results: At the time of analysis, 142 subjects had completed the education session. Improvement was seen in knowledge of treatment schedule (mean score increase from 2.5 to 3.4, p<0.001), side effects (mean score increase from 2.3 to 3.4, p<0.001), and how to use medications designed to prevent and treat nausea (mean score increase from 1.8 to 3.2, p<0.001). There was significant reduction in patient anxiety about starting treatment (mean score decrease from 2.3 to 2, p<0.001) and anxiety related to treatment side effects (mean score decrease from 2.3 to 2, p<0.001). Analysis of anxiety by age showed that those age <65 had higher baseline anxiety scores with a reduction in anxiety after the education session while those age ≥65 had lower baseline anxiety scores with a rise in anxiety after the education session (Table). Conclusions: A pre-chemotherapy teaching session improves patient knowledge about the planned treatment along with reduction in anxiety. Change in anxiety differs between patients 65 years of age and older as compared to those less than 65. [Table: see text]
Are needs of stakeholders in cancer care being met? A novel approch to assessing needs to improve value in cancer care.
Authors: Patel Manali I. , Moore David , Randolph Shannon , Wakelee Heather A. , Blayney Douglas W. , Milstein Arnold 
Published: March 2020

6581 Background: Advanced cancer is a leading cause of death in the US. While treatments have improved, patients still report physical, emotional, and financial burdens associated with the disease. In order to improve cancer care, a comprehensive examination of unmet needs among patients, health care professionals, and other stakeholders is required to develop interventions that can improve patient outcomes, experience, and reduce healthcare spending. Methods: A national convenience sample of patients, families, caregivers, healthcare professionals, payer groups, and healthcare delivery systems who have experience with cancer care were selected for participation. A 10-question survey was administered to participants regarding their experiences with current cancer care. A novel combination of Grounded theory, Stanford d.school and bio-design needs-findings methodologies were used to assess and prioritize needs. Results: A total of 273 participants presented 99 unique needs over the study period. Needs were organized into five categories: 1. Monitor/Intervene Patient Clinical and Symptom Data 2. Shared Decision-Making 3. Best Practice Communication 4. Integrated Care Team 5. Patient-Tailored Care. The most common needs of cancer patients were improved symptom control. Needs among providers focused on minimizing tasks that could be performed by others. Payer needs reflected improved value in care. Family and caregiver needs reflected shared decision-making in treatment plans. Healthcare delivery system needs included improved guideline development, evidence-based care, and report of quality metrics. Conclusions: A novel methodology to assess, analyze, and organize unmet needs in cancer care reveals that the top concerns among stakeholders are better symptom control, enhanced efforts to improve patient care commensurate with patients’ values, and a more tailored approach to coordinate care delivery using guideline-based care with attention to quality metrics. Future studies should draw upon these needs to develop targeted interventions for patients with advanced cancer that can improve experience, clinical outcomes, and reduce healthcare spending.
Are oncologists involved in cancer biomarker decisions at their institutions?
Authors: Weldon Christine B. , Trosman Julia R. , Benson Al Bowen , Tsongalis Gregory J. , Siziopikou Kalliopi P. , Gradishar William John , Schink Julian C. 
Published: March 2020

6617 Background: Biomarkers play a critical role in oncology, but differences in accuracy and quality exist between different testing methods for specific markers. ASCO/CAP guidelines call for oncologists, on behalf of patients, to seek information on testing quality and to obtain assurance that testing laboratories are appropriately accredited (Wolff et al, JCO, 2007). We surveyed oncologists and pathologists from the NCI designated cancer centers to collect individual perception of their institution’s decision making on biomarkers, and awareness of lab quality accreditation. Methods: We conducted an IRB approved web survey of pathologists and oncologists at the 58 NCI designated cancer centers providing adult breast, gastric, esophageal and non small cell lung cancer care. The survey included 12 questions on institutional decision processes and lab quality accreditation. We analyzed results using simple frequencies and the Fisher's exact test. Results: The study achieved a response rate of 98% (57/58 sites), with survey responses from 115 pathologists and 156 oncologists. The perception that their institution uses a formal organizational review and decision process on new biomarker tests was reported by 47% (54/115) of pathologists and 31% (48/156) of oncologists (p= .0078). 22% (33/153) of oncologists report they are always involved in institutional decision making on biomarker method selection for their specialty. Awareness of CAP certification status for their institutional laboratory was reported by 88% (99/112) of pathologists and 46% (65/142) of oncologists (p <0.0001). Awareness of whether their institutional laboratory underwent CAP HER2 IHC and/or FISH proficiency testing was reported by 70% (53/76) of pathologists and by 21% (13/63) of oncologists who treat breast cancer (p<.0001). Conclusions: Oncologists are typically not actively involved in their institution’s decision making process to select biomarker testing methods, nor are many of them aware of their institutional lab’s quality accreditation. With the ever increasing role of biomarkers in cancer care, oncologists’ awareness of biomarker testing performance and their participation in decision making related to biomarkers will become critical.
Prospective study of cognitive function (cog fcn) in women with early-stage breast cancer (BC): Relationship between perceived and measurable cognitive deficits.
Authors: Heflin Lara , Fang Sally , DeLuca Amy N , Melisko Michelle E. , Moasser Mark M. , Park John W. , Chien Amy Jo , Munster Pamela N. , Esserman Laura , Landau Susan M , Jagust William J , Kramer Joel H , Rugo Hope S. 
Published: March 2020

6619 Background: Cognitive complaints are common among patients (pts) receiving adjuvant therapy (Rx) for early stage BC. Longitudinal prospective data is needed to help understand the relationship between measured cog fcn, patient reported cognitive changes, and patient reported depression and fatigue. We conducted a prospective trial to evaluate the effects of chemo- (CTX) and hormone therapy (HRx) on brain and cog fcn in pts with early stage BC using multiple objective and subjective tests as well as MRI/PET imaging. Here we report relationships between objective measures and patient reported outcomes (PRO). Methods: Eligibility included female pts planning to receive adjuvant Rx for ESBC. Pts were enrolled in 3 Rx groups (grps): CTX, CTX & HRx, and HRx, with a 4thno Rx age/education matched control group. All pts underwent a battery of objective and subjective cog tests before start of rx, 1 mo after CTX or 5 mo after start of HRx (FU1), then 9 mo (FU2) and 18 mo (FU3) after CTX. Brain MRI, PET and serum estradiol were performed at baseline, FU1 and FU2. Results: 81 pts were enrolled as follows: 14 CTX, 33 CTX & HRx, 22 HRx, and 12 control. 90% completed FU1, 72% FU2, and 62% FU3, with 29 pts waiting to complete testing. Demographics were similar between grps, median age was 54 (range 34-71), 78% were Caucasian. At FUP1, depression (BDI-II) and fatigue predicted poorer overall perceived cog fcn (FACT-Cog); decline in letter fluency (FAS) on cog testing also predicted poorer overall perceived cog fcn (FACT-Cog). Decline in verbal memory (CVLT-II) predicted perceived memory deficits (FACT-Cog Memory), even after controlling for depression and fatigue. Conclusions: In pts receiving adjuvant Rx for early stage BC, depression, fatigue, and decline in letter fluency predicted poorer perceived cog fcn. Decline in verbal memory independently predicted perceived memory deficits, demonstrating that PRO are related to actual deficits in cog fcn. Future intervention studies should focus on these factors. Funding: NIH R01 1AG025303-01A2. Clinical trial information: NCT00755313.
Results of a feasibility analysis of quality indicators for outpatient cancer care.
Authors: Hermes Kerstin , Baumann Walter , Zimmermann Andreas , Schmitz Stephan H. 
Published: March 2020

6623 Background: Quality indicators are increasingly used for measuring quality of care, for internal quality assurance, confidential benchmarking processes and anonymous quality reporting. The WINHO quality indicators project aims to develop and examine process quality measures for outpatient cancer care in Germany. This project is fully funded by the German Cancer Aid (Deutsche Krebshilfe). Currently, a set of 46 quality indicators exists. To gain better insights into what data can be retrieved from patient records and documentation systems in oncology practices, a feasibility analysis was conducted prior to data collection. Methods: 2176 questionnaires focusing on different aspects of the feasibility of quality indicators were sent to 295 doctors of WINHO partner practices. 1089 questionnaires were answered. Hence, for each of the 46 WINHO quality indicators 20 to 27 answers are available. Results: Although about 80% of the data required for the indicators are documented in patient charts, less than 30% of the data can be retrieved electronically. Particularly, data for indicators of the quality of pain management, holistic and palliative care often cannot be retrieved easily. By contrast, data on basal documentation, therapy planning and implementation are easier to obtain from patient charts. As a result, these indicators experience better evaluations by the office-based oncologists regarding frequency of occurrence, acceptance and reliability. However, high standard deviations show that documentation habits vary considerably within the group of office-based cancer specialists. Conclusions: Despite the large amount of data documented by oncologists in everyday practice, the information required to measure quality of care with indicators is complicated by low retrievability of data. Facilitating improved documentation and IT systems in oncology practices would ease the collection and examination of the rich information documented by office-based oncologists.
The lifetime economic burden of inaccurate HER2 testing: Comparing false positive and false negative HER2+ early breast cancer patients in the United States.
Authors: Garrison Louis , Babigumira Joseph , Masaquel Anthony , Wang Bruce , Lalla Deepa , Brammer Melissa 
Published: March 2020

6626 Background: Trastuzumab is administered to patients with early breast cancer (EBC) whose tumors test positive for HER2 using IHC or FISH diagnostic tests. However, due to test characteristics and testing heterogeneity, patients may be misdiagnosed as false positive (FP) or false negative (FN). This analysis estimates the lifetime economic burden of inaccurate HER2 testing in the US. Methods: We developed a national-level economic model to estimate the impact on healthcare costs and quality-adjusted life years (QALYs) in both groups in 2012. The model estimates the expected number of FP and FN patients using literature-derived estimates of each test’s sensitivity, specificity, and utilization. Based on estimates from the literature, a FP patient would generate unneeded trastuzumab costs of about $56,000 and experience a chance (2.9%) of related cardiotoxicity; an FN patient would save $56,000 in trastuzumab costs, but lose 1.7 QALYs of life expectancy and face a greater likelihood of recurrence and associated costs ($42,000) to treat metastatic disease. A net monetary benefit approach (valuing healthy life years at $100,000) is used to compare the lifetime economic burden for FP and FN. Results: The estimated overall proportions of FP and FN are 2.8% and 2.2% of 227,000 EBC patients, resulting in about 6,400 and 5,000 women in each group, respectively. Overall, approximately 8600 QALYs would be lost among FN patients who do not receive trastuzumab. We estimate the incremental per-patient lifetime burden of an FP to be about $57,000, and for an FN to be about $118,000. The implied incremental loss to society for FPs is $362 million and for FNs is $596 million. Conclusions: Current testing practices and treatment patterns for HER2+ EBC patients result in misdiagnosis and non-optimal treatment in approximately 11,500 patients each year: the combined total economic loss to society is nearly $1 billion. The greater share of the loss is among FN patients who would have benefited from trastuzumab, but did not receive it. The significant annual burden of HER2 misdiagnosis suggests that substantial societal investments to improve HER2 test accuracy should be considered.