bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systemic therapy (ST) in cancer patients ≥ 80 years of age: A Manitoba population-based assessment
Authors: Gingerich J. R. , Turner D. , Xiaoyun S. , Czaykowski P. 
Published: March 2020

6090 Background: Little is known about the cancer characteristics, treatment options and outcomes in the oldest subset of the elderly, those ≥ 80, who develop cancer. Methods: We employed a population-based, cross-sectional design utilizing the provincial cancer registry and administrative data augmented by clinic-specific retrospective chart review to study the demographics, treatment and outcomes of patients ≥ 80 diagnosed with cancer in the years 2002–2003 in Manitoba, Canada. We assessed treatment patterns for various subgroups (analyzed using chi-square and Fisher’s exact tests to determine association, as appropriate) and associated survival. Results: Our cohort included 2,194 patients. This represented 20.8% of all incident cases. The median age was 84 (range: 80–102), with a slight preponderance of females (53%). As expected, prostate, lung, and colorectal cancers were most common for males with breast, lung, and colorectal cancer being most common for females. Only 241 (10.9%) of the cohort were referred to the central cancer centre for consideration of ST which was less than the overall referral rate of 33%. Of those referred, 57% did not receive ST, 20% received palliative ST, and 23% received adjuvant/curative ST. The two year survival rates were statistically significant by treatment categories (not referred = 39%, referred but who did not receive ST = 39%, palliative ST = 27%, and adjuvant/curative ST = 76%,) (p<0.0001). The Charlson score for those patients referred who received ST was lower than those who did not receive ST (p<0.0001) Conclusions: Our data indicate that in patients ≥ 80 years of age with cancer, few are referred to the central cancer clinic for ST. Of those referred, patients who receive adjuvant/curative intent ST live longer then those not receiving ST. Lower Charlson scores (indicative of fewer comorbidities and better general health) were found more often in patients receiving ST. No significant financial relationships to disclose.
Cancer screening tests in France: First results of EDIFICE study
Authors: Pivot X. , Serin D. , Coscas Y. , Eisinger F. , Rixe O. , Roussel C. , Morere J. , Blay J. 
Published: March 2020

6092 Background: The EDIFICE study was the first which aimed to allow better understanding of population’s adhesion in France to the screening tests available for the 4 most frequent cancers: breast, colorectal, prostate and lung. Methods: This nationwide observational study was carried out in France from January 18th to February 2nd, 2005 among a representative sample of 1,504 subjects aged between 40 and 75 years and a representative sample of 600 general practitioners (GPs). Information collected about participating subjects included socio-demographic characteristics, attitude towards cancer screening and actual experience of cancer screening, and about GPs’ medical practice regarding screening. Results: A striking result observed is that screening for colorectal cancer that USPSTF rates as an “A” Recommendation (strongly recommended) deserves less attention: reported rate 25% than prostate cancer screening (either with digital rectal examination and/or PSA): reported rate 36%. In the same way, GPs’ are recommended more often prostate cancer screening (58%) than colorectal cancer screening (18%). Another key result of that EDIFICE national representative survey is the high attendance rate of women at mammography screening. Conclusion: With respect to the cost of such programs, utilization must be monitored and compared among different countries/organization. Additional data will be presented about reasons to do or not cancer screening and about regularity of screening. [Table: see text] No significant financial relationships to disclose.
A new model for training patient advocates to advance the adoption of research results in community oncology practices
Authors: Railey E. , Smith M. , Perotti J. 
Published: March 2020

6094 Background: The advocate community has been identified as an influential component in disseminating the results of research reported at ASCO. A pilot program offered by Research Advocacy Network prepared advocates to better understand the common concepts in oncology, improve statistical skills to interpret the presentations and identify the influencers and barriers to adoption of research results in clinical practice. Methods: Advocates were selected based on their ability to disseminate results reported at ASCO to a patient constituency. Pre-ASCO webconference lecture topics included: targeted therapies, drug safety and approval process, statistics for advocates. Post ASCO webconferences explored evidence-based medicine principles with case presentations and discussions. Participants were responsible for reporting their efforts in disseminating the results that could change clinical practice in their disease site. Results: Fifteen advocates representing six cancer sites participated in the program. Six of the participants were first time attendees. Participants reported an increased 1) understanding of scientific concepts and language; 2) increased confidence in dialoguing with researchers; and 3) improved ability to translate research results for their constituencies. Research results were provided by the participants to staff and volunteers, via teleconferences, web sites and individually to newly diagnosed patients, caregivers, support groups, survivor hotlines and in newsletter articles with a combined circulation of over 125,000 readers. Conclusions: Preparatory lectures help advocates maximize the experience of interpreting and translating the results from the ASCO meeting. More prepared advocates help to advance the dissemination of research results through their formal and informal distribution channels and are able to translate the information more rapidly to their constituencies. No significant financial relationships to disclose.
Knowledge of cancer clinical trials in a population being screened for cancer
Authors: Walsh J. H. , Sahasrabudhe D. 
Published: March 2020

6095 Background: Only 2.5 percent of adult cancer patients enrolled in cooperative group clinical trials between 1998 and 1999. Increasing participation in clinical trials is important in efforts to improve cancer care. Methods: We administered an anonymous true/false questionnaire that assessed knowledge of clinical trials to 117 men seeking prostate cancer screening. Questions involved the rationale for conducting clinical trials, regulatory oversight of clinical trials, informed consent, randomization, blinding, use of placebos, and safeguards built into clinical trial design. We performed multi-way ANOVA and t-test analyses to compare the average proportion of correct responses by group. Results: On 71 percent of test questions, participants chose the correct answer 80 percent or more of the time. Descriptive general statements about the conduct of clinical trials were answered correctly 88 percent of the time. Questions in which participants scored less than 80 percent involved randomization, blinding, and the use of clinical trials to improve cancer treatments. 45 percent incorrectly answered a question about placebo use. Results of the univariate t-tests and multi-way ANOVA suggest that white men and employed men are significantly more knowledgeable about clinical trials. College educated men also appear somewhat more knowledgeable about clinical trials, although this effect does not attain statistical significance when other predictors are controlled. Marital status, age, health insurance status and income do not have a significant effect on men’s knowledge. Conclusions: Percent of participants answering correctly decreased for concepts such as randomization, placebo use, and blinding. A belief persists that placebos will be used in cancer clinical trials. This may play a role in low accrual, and may be an area in which educational interventions could improve accrual. This study identifies specific concepts, beliefs, and populations that have to be addressed to improve enrollment on cancer clinical trials. [Table: see text] No significant financial relationships to disclose.
Extending the patient navigator research program from Harlem to the nation
Authors: Garcia R. , Freund K. M. , Dudley D. , Fiscella K. , Jones J. D. , Patierno S. R. , Raich P. C. , Roetzheim R. G. , Paskett E. , Bennett C. L. 
Published: March 2020

6096 Background: Low-income persons face barriers when attempting to seek cancer diagnostics tests and treatment. In 1990, Harold Freeman implemented a novel patient navigator program for women with abnormal mammograms, resulting in earlier presentations and better survival. Identified barriers included lack of insurance, poor social support, coping styles, health beliefs such as fatalism, and poor health literacy skills. Single-site navigator programs have been subsequently implemented. Building on these experiences, the National Cancer Institute is supporting navigator programs at 9 sites. Methods: At 9 sites, the skill set of the navigators, community partnerships, target patient populations were reviewed for information regarding cancer type, number of patients seen, and navigator type. Common data elements include time to diagnosis and time to initiation of treatment, navigation costs, cost-effectiveness of the intervention (in order to address sustainability), and navigation satisfaction. Results: See Table . Conclusions: While programs such as the Breast and Cervical Cancer Treatment Act, the Department of Veterans Affairs, and the Indian Health Board provide financial support to pay for diagnostic/treatment services, the Patient Navigator Research Program will provide medical, social, and psychosocial services for 5,295 patients with positive breast cancer screens, 3,528 patients with positive cervical cancer screens, 5,507 patients with colorectal cancer screens, and 1,167 patients with prostate cancer screens. Diversity of sites, navigator skill sets, patient eligibility, sociodemographics, and study design in conjunction with common data elements, outcomes, and analytic plans will allow us to assess the efficacy and costs of a range of navigation programs. [Table: see text] No significant financial relationships to disclose.
Surgical oncology outcomes: The role of nurse practice environments
Authors: Friese C. R. , Aiken L. H. 
Published: March 2020

6105 Background: Increased attention has focused on the role of hospital characteristics on cancer patient outcomes. We examined two cancer-specific credentials, as well registered nurse practice environments, on outcomes of care. Methods: Through secondary analysis of existing data from hospital claims, the tumor registry, and a statewide of survey of nurses (RNs), we studied 30-day mortality (D) and failure to rescue (death given a complication) (FTR) for surgical oncology patients treated in 164 Pennsylvania hospitals from 1998–1999 (N=24,618). We compared D and FTR rates by a hospital’s NCI cancer center designation, American College of Surgeon’s (ACoS) cancer program approval and categorized scores on the Practice Environment Scale of the Nursing Work Index (PES-NWI). The PES-NWI scales measure RN participation in hospital affairs, RN foundations for quality of care, nurse manager leadership/support, staffing/resource adequacy, and RN-physician relations. Multivariate logistic regression models examined predictors of D and FTR, controlling for 25 patient variables. Standard errors were corrected for patient clustering in hospitals. Results: NCI centers had lower D and FTR rates (p < .01). ACoS hospitals had lower D and FTR rates (ns). Hospitals with low scores on PES-NWI scales had the poorest outcomes (p < .01). In logistic regression models, significant predictors included unfavorable PES-NWI Scores for D (OR=1.32, 95% CI: 1.06–1.65) and FTR (OR=1.39, 95% CI:1.03–1.88), and NCI centers for D (OR=0.64, 95% CI: 0.50–0.83) and FTR (OR=0.67, 95% CI: 0.47–0.96). The NCI effect lost significance when environment was included. ACoS program effects were small (OR= 0.99, p = .90) for both outcomes. Conclusions: Favorable outcomes in NCI centers may be partly explained by practice environments. The practice environment of RNs significantly predicts surgical oncology patient outcomes, and should be a focus of quality improvement activities. No significant financial relationships to disclose.
Treatment efficacy and tolerance in geriatric oncology
Authors: Kumar A. , Soares H. P. , Balducci L. , Djulbegovic B. 
Published: March 2020

6115 Background: Elderly patients share the majority of the disease burden in cancer. Although 61% of new cancer cases occur among elderly, yet elderly comprise only 25% of the patients enrolled in clinical trials. A systematic review to assess the accurate participation of elderly in randomized clinical trials (RCT) has not been done. Methods: We reviewed all consecutively completed phase III RCTs conducted by 5 National Cancer Institute sponsored cooperative groups. Published papers and study protocols were used to ensure the accuracy of the data extraction. We used a cut-off of age ≥65 to define elderly patients. For trials that did not have an exclusive ≥65 age criteria for enrollment, data were extracted on number of participants ≥65. Outcome between the innovative and the standard treatment was compared. Data were extracted as per the methods recommended by the Cochrane Collaboration. Results: Out of 413 studies, only two trials exclusively enrolled elderly patients (0.5%). 57% (n=235) of the trials did not have any stratification by age. Only 10% of the studies had a stratification age at ≥65 (n=42). Contrary to the general notion that elderly may not respond well to newer chemotherapy combination treatments, overall survival in these two trials exclusively enrolling elderly favored the newer treatments [Hazard ratio (HR) 0.62(95%CI 0.44, 0.87)]. In addition, trials enrolling >40% of elderly had favorable outcomes involving innovative treatments for survival and event-free survival [HR survival 0.85(95%CI 0.77, 0.94), HR event-free survival was 0.76(95%CI 0.64, 0.92)]. Treatment related mortality was similar in the innovative and the standard arms [HR 0.87(95%CI 0.39, 1.96)]. Conclusions: Our data indicate that enrollment of elderly in experimental RCTs is not associated with increased harms to this patient population. Increased participation of elderly may help in finding new treatments that are clinically applicable specifically to this cohort of patients. No significant financial relationships to disclose.
A prospective evaluation of the attitudes of patients, physicians and nurses using a computer-assisted quality of life instrument (LCSS-QL) in a multicenter clinical trial in non-small cell lung cancer (NSCLC)
Authors: Gralla R. J. , Hollen P. J. , Leighl N. , Meharchand J. M. , Krieger H. , Solow H. 
Published: March 2020

6123 Background: The LCSS has been computerized (LCSS-QL) for inexpensive hand-held devices (pocket-pc) to enhance feasibility, provide immediate results, and automatically record data. Correlation coefficient between paper form and electronic version is excellent (r=0.93). This analysis determines the acceptability and value of LCSS-QL assessed by patients and health care professionals. Methods: NSCLC patients utilized LCSS-QL in a clinical trial and also completed a form evaluating their experiences after their first and third treatment cycles. All received docetaxel and platinum. Eleven physicians and nurses administered LCSS-QL and completed an evaluation form. The evaluation included: time required, satisfaction with the process, value of assessment, impact on communication, resource utilization. Results: The evaluation form was completed by 126 patients (cycle 1) and 94 (75%) completing cycle 3. Baseline characteristics: Stage III/IV 29/71%; median KPS 80%; 56% male; median age 69 yrs. Results are in the table : All physicians considered their time per patient was not lengthened and 80% felt that QL evaluation could save time. 67% of nurses felt the instrument could save time, while 83% felt that their time with patients was lengthened. Utilization: 67% of professionals reported QL evaluation would identify earlier patients not benefiting from chemo; 91% were more aware of pain issues. Conclusions: Patients and health-care professionals found using a validated QL instrument in a computerized form via a hand-held device was easy, added value and satisfaction while enhancing communication and awareness of PRO issues. This electronic format added no physician time. These results indicate that this QL evaluation method should be used more frequently in clinical trials and patient management. Supported in part by a grant from Sanofi-Aventis Canada, Laval, QC. [Table: see text] [Table: see text]
Survey amongst health care professionals—Willingness to pay for novel therapies
Authors: Chia W. K. , Hee S. W. , Toh H. C. 
Published: March 2020

6138 Background: Singapore’s state sponsored healthcare system provides subsidies for “standard” oncology drugs (patients co-pay). Patients pay full cost for access to newer therapies prior to Government assessment for subsidy eligibility. Methods: A questionnaire-based study was performed to determine willingness to pay (WTP) for newer anti-cancer therapies (Herceptin, Avastin, Iressa). In addition to absolute dollar cost, patients were asked to tradeoff material goods (cars, house, electronic goods) to purchase such drugs. Face to face interviews were conducted amongst HCP by a single interviewer at Singapore National Cancer Centre from 24 Nov to 16 Dec 06. The questionnaire provided didactic information of such drug benefits in either the appropriate adjuvant or palliative setting. Results: Population: 70 out of 76 HCP responded to the survey—36 doctors (radiation and medical oncologists) and 34 oncology nurses. 60% were female, 61% married and 48% had dependent children. 71% supported parents financially. Median length of practice for doctors(drs) was 10 years (range 2 to 35) and 9 years (range 2 to 29) for nurses(nrs). Median income bracket was USD 3000–5000/mth and USD 1200–3000/ mth respectively. Findings: 69% of respondents reported WTP for herceptin (97% for drs and 38% of nrs). Although drs were most able to afford herceptin, they also demonstrated the highest willingness to trade off material goods to pay for treatment. 57% would sell their houses and 71% sell their cars to pay for herceptin. Almost the entire cohort reported willingness to forego discretionary spending on restaurant dining, clothes and electronics. Only 20% of respondents were WTP for palliative avastin for advanced colon cancer. 53% were willing to pay for a trial of Iressa (for advanced non-small cell lung cancer). If response was favorable, 68% were willing to sell their house to pay to continue palliative treatment. This survey must be interpreted in the context of a relatively affluent Asian population. Conclusions: Government healthcare programs worldwide will find increasingly difficulty paying for expensive novel therapies. At an individual level, respondents demonstrate a high WTP and forego substantial material goods for access to such novel agents. No significant financial relationships to disclose.
Medical oncologists’ skill and understanding of epidemiology and statistical principles need to be strengthened to maximize their use of clinical trial results
Authors: Hoffman K. R. 
Published: March 2020

6139 Background: Clinical oncologic practice is based on evaluating data from studies whose results are statistically defined, increasingly from interim analyses. How well the practicing oncologist understands the correct use of these statistical and epidemiologic methods is unknown. Methods: Twenty (20) board-certified community based medical oncologists agreed to take a ninety minute, twenty-five question exam on epidemiology and statistics to test their competence in evaluating current treatment data. This test was based on abstracts and articles presented within the last three years and basic statistical and epidemiology concepts taught to second-year medical students Results: Only 11/20 oncologists had a passing grade of 70% (range 92–24%, mean 72%). The recognition of different phased clinical trials was correctly identified by 17/20 doctors. While the identification between a retrospective vs. prospective study was perfect, only 7/20 respondents correctly identified what information can be obtained from a retrospective study. 11/20 respondents correctly explained a ‘p‘ value. Correct calculations and explanations of the sensitivity, specificity, positive and negative predictive value of screening test ranged between 8/20 and 13/20. The importance of a study’s sample size in defining statistical ‘significance‘ was recognized by 9/20 respondents. Only 5/20 oncologists could explain a ‘hazard ratio‘ while14/20 correctly found survival information off of a Kaplan-Meier survival plot. Only10/20 correctly explained a ‘forest plot.‘ Most doctors knew ‘incidence‘ and ‘prevalence‘ but not ‘lead time bias.‘ The identification of ‘absolute risk‘ vs. ‘relative risk‘ (6/20) and understanding the concept of a ‘Type I‘and ‘Type 2‘ error was poor (8/20). After completion of the exam all respondents agreed that CME opportunities in this field would be very helpful. Conclusions: A confirmatory study should be done. In the meantime, there seems to be a need to improve the competence of the practicing oncologist in evaluating data and clinical trials. ASCO should include this topic in future free (not ticketed) educational symposiums at our national meetings and as part of their regional programs. No significant financial relationships to disclose.