bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disparities in COVID-19 severity and risk of death in cancer patients: Experiences from a U.K. cancer center.
Authors: Russell Beth , Moss Charlotte L , Papa Sophie , Wylie Harriet , Haire Anna , Cahill Fidelma , Lei Mary , Ghosh Sharmistha , Sullivan Richard , Rigg Anne Sagar , Dolly Saoirse , Van Hemelrijck Mieke ,   Guy's Cancer Real World Evidence Programme
Published: October 2020

285 Background: There has been widespread evidence emerging regarding disparities between COVID-19 outcomes in patients of varying ethnicities and background. It is, however, unclear how various patient characteristics affect COVID-19 severity and risk of death in a cancer population. Methods: Our Cancer Centre was at the epicentre of the COVID-19 outbreak in the UK. A total of 156 cancer patients had a confirmed COVID-19 diagnosis between the 29th of February through the 12th of May 2020. Logistic/Cox proportional hazards models were used to identify which demographic and/or clinical characteristics were associated with COVID-19 severity/death. The regression models were defined through a directed acyclic graph (DAG) to decide upon the minimal adjustments required for each statistical model. Results: Of the 156 COVID-19 positive cancer patients, the most frequently reported tumour types were urological/gynaecological (29%), followed by haematological (18%) and breast (15%). 128 (82%) presented with mild/moderate COVID-19 and 28 (18%) with severe disease. Initial diagnosis of cancer >24m before COVID-19 (OR:1.74 (95%CI: 0.71-4.26)), presenting with fever (6.21 (1.76-21.99)), dyspnoea (2.60 (1.00-6.76)), gastro-intestinal symptoms (7.38 (2.71-20.16)), or higher levels of CRP (9.43 (0.73-121.12)) were linked with greater COVID-19 severity. During median follow-up of 37 days, 34 patients had died of COVID-19 (22%). Asian ethnicity (3.73 (1.28-10.91), palliative treatment (5.74 (1.15-28.79), initial diagnosis of cancer >24m before (2.14 (1.04-4.44), dyspnoea (4.94 (1.99-12.25), and increased CRP levels (10.35 (1.05-52.21)) were positively associated with COVID-19 death. Socioeconomic status (SES) was not found to be associated with either COVID-19 severity or risk of death. We will present updated data with more mature follow-up. Conclusions: In cancer patients, Asian ethnicity was found to be positively associated with COVID-19 death compared to Caucasian patients. However, SES was not associated with COVID-19 severity or risk of death thereby implying this was not due to poor access to healthcare. Future studies hence need to identify the underlying biological and/or societal reasons explaining these ethnic disparities in COVID-19 outcomes for cancer patients.
Treatment patterns in extensive-stage small cell lung cancer: A retrospective real-world data study.
Authors: Ganti Apar Kishor , Katranji Kenan , Seal Brian S. , Brannman Lance 
Published: October 2020

288 Background: Etoposide plus platinum-based chemotherapy (EP) was the first-line (1L) extensive stage small cell lung cancer (ES-SCLC) standard of care for many years. 1L treatment with immunotherapy (durvalumab or atezolizumab) combined with carboplatin (durvalumab, atezolizumab) or cisplatin (durvalumab) chemotherapy (CT) is now being accepted as the new standard of care in this population. This study used real-world data to describe treatment patterns of ES-SCLC patients in the United States following the introduction of immunotherapy (IO). Methods: Data for patients ≥18 years of age with an index ES-SCLC treatment from 17 October 2018 to 30 November 2019 (or no 1L treatment within 60 days of an index diagnosis during this period) were drawn from the Flatiron electronic medical records database. Proportions of patients receiving specific 1L and second-line (2L) treatments were calculated. Times from (a) index diagnosis to 1L start, (b) 1L start to 1L end (c) 1L start to 2L start, and (d) 2L start to 2L end were calculated with 95% confidence intervals (for sample sizes ≥ 30) for the CT and IO+CT treatment categories. Results: 568 patients met the inclusion/exclusion criteria: 77 (14%) were untreated 60 days after their index diagnosis; 491 received 18 different 1L treatments (1L CT: 195; 1L IO+CT: 286, other 1L therapy: 10); and 119 received 2L treatment following 1L CT or IO+CT. The table shows the most frequently occurring 1L and 2L treatments. The mean number of days [#patients, 95% confidence interval] for 1L CT and 1L IO+CT respectively were (a) index diagnosis to 1L start: 22 [194 (1 patient began 1L therapy prior to their index diagnosis); 20–26], 22 [286, 20–24]; (b) 1L start to 1L end: 58 [174, 52–66], 91 [125, 79–103]; (c) 1L start to 2L start: 115 [83, 99–133], 186 [36, 168–205]; (d) 2L start to 2L end: 55 [54, 42–69] and 36 [N = 21]. Conclusions: Most ES-SCLC patients started therapy within a month of diagnosis. Over 50% received 1L IO+CT, reflecting its rapid uptake in the US. Almost 14% patients did not receive 1L treatment and only ~25% of 1L CT and 1L IO+CT patients received 2L therapy within the study period; reasons for this warrant further investigation. [Table: see text]
Digital engagement preferences of individuals aged 65 and older with cancer.
Authors: Allison Matthew , Patterson Jonathan , Burton Stephen , Patel Dhiren , Brassil Kelly Jean 
Published: October 2020

289 Background: Recent reviews suggest that digital solutions play a prominent role in the context of geriatric oncology. While interventions ranging from remote monitoring to nutrition and physical activity support have demonstrated feasibility in older adults (aged 65 and older), little is known about facilitators and barriers to eHealth uptake in older adults diagnosed with cancer. Insights into the digital engagement preferences of older adults with cancer may help to inform which platforms may be best aligned to optimal engagement and outcomes. Methods: A retrospective analysis was conducted to examine patient engagement preferences (phone, text and/or email) among older adults with cancer enrolled in a digital health coaching program. Descriptive statistics were used to summarize patient characteristics. Chi-square tests were used to evaluate differences in patient engagement preferences by race. Results: Of 513 individuals, the majority (n = 308; 60%) preferred information be provided by phone, email and text, while 20% (n = 105) requested content by phone and text only. Less than 10% of the sample requested content via phone only (n = 45; 8%), phone and email, (n = 31; 6%), email only (n = 11, 2%), or by email and text (n = 9; 2%). Interestingly, adults aged 65 and older had a significant predisposition to phone only communication (8.77%) compared to 2.25% in the general oncology population (p < 0.001). Among adults aged 65 and older with a phone preference, there were on average 8.39 calls over the course of the program with an average of 9.51 minutes per call over the course of 12-weeks. For those with text message preference, there were an average of 14.17 outbound and 8.30 inbound texts over the 12-week engagement, and for those with email preference a 62.38% open rate was observed. Retention over a three month coaching period was highest among those engaged via phone, text and email (56.17%), and email only (54.55%). Race was significantly related to engagement preference, with black members twice as likely (p < 0.001) to choose phone and text, and three times as likely (p < 0.001) to choose phone only compared with white members. However, no differences emerged between race and retention. Conclusions: Engagement preference was associated with differences in retention and race. Our results highlight the importance of offering different mechanisms for patient engagement and the need for attention to specific demographic differences such as race, which may impact access to and preference for engagement types when employing digital health solutions for older adults with cancer.
Review of time to treatment for head and neck cancer patients at a rural Maine cancer center.
Authors: Harb Antoine Joseph , Curtis Adam 
Published: October 2020

292 Background: Time to Treatment (TTT) for head and neck (H&N) malignancies were reviewed for all patients treated at Northern Light Cancer Institute, from 2013 to 2017. A total of 297 cases were identified. Methods: TTT was defined as time of tissue diagnosis by biopsy to the first treatment day. Data was compared to a comprehensive study of 51,655 cases conducted by Murphy et al (JCO, 34; 2, Jan 10, 2016). Median days to treatment were compared by tumor site and treatment modality. Comparison of the distribution of cases where TTT exceeded the critical time point of 67 days (determined by Murphy) was also made. The primary mode of treatment was a combination of chemotherapy and radiation (concomitant) in 39.5% of patients. Other treatment modalities included radiation only (17.2%), and surgery, either as stand-alone treatment, or followed by subsequent additional treatment (32.4%). These treatment modalities comprise 89.1% of all cases. Results: We identified 82 (27.7%) patients with oral cancer, 99 (33.5%) with oropharyngeal malignancy and 92 (31.1%) with laryngeal cancer. Median TTT was 40 days (compared to 34 days found by Murphy) for chemo-radiation patients, 42 (versus 31) for radiation only, and 34 (versus 17) for surgery. TTT for surgery patients was significantly shorter than the other two treatment modalities (p < 0.05). There were no significant differences in TTT based on primary site. All comparisons to Murphy (treatment and primary site) were significantly lower than our median values (p < 0.05). Median TTT over 5 years maintained the same relationship between the treatment modalities. 29.2% of our patients were treated within 30 days, 50% from 31-52 days, 10.6% from 53-67 days, and 10.2% beyond 67 days, compared with 59.5, 23.3, 8.3, and 9% respectively found by Murphy. Conclusions: TTT for H&N cancers has been relatively stable over the 5-year time course examined. The majority of our patients (50%) are treated in the 31-52 day timeframe compared with the first 30 days (59.5%) with Murphy. Our data suggest similar percentages (10.2 versus 9%) after which patients had poorer outcome. Further efforts should be entertained to make sure patients are seen sooner in the oncology clinic.
Evaluation of a centralized toxicity view in the electronic health record (EHR) for physician-recorded Common Terminology Criteria for Adverse Events (CTCAE).
Authors: Levin-Epstein Rebecca , Ma Martin , Jiang Naomi Y. , Valle Luca Faustino , Yoon Stephanie , Jablonsky David , Steinberg Michael L. , Kishan Amar Upadhyaya , Wu Allan D. , Raldow Ann C. 
Published: October 2020

296 Background: Patients’ treatment-related acute and late toxicities are essential clinical data, yet this information is widely dispersed among notes in the EHR. This lack of structure impedes clinician ability to efficiently and comprehensively integrate toxicity information into clinical management. We aimed to consolidate toxicity data to improve clinician efficiency in accessing this information, and to evaluate the utility of this tool in radiation oncology. Methods: We developed an auto-updating flowsheet view (“Synopsis”) in the Epic EHR that longitudinally integrates physician-graded CTCAE toxicity selected using a SmartForm embedded in EHR notes. Physicians timed themselves performing 4 tasks to assess acute and post-treatment toxicity information for patients seen in follow-up, alternating with vs. without use of Synopsis. Wilcoxon Rank-Sum testing compared recorded task times with and without Synopsis. A survey was sent to physicians regarding qualitative utility of Synopsis. Results: Six physicians reviewed 98 patients seen in follow-up (49 with Synopsis, 49 without Synopsis) at median 8.1 months (Synopsis) and 6.5 months (no Synopsis) since completion of radiation (p = 0.88). Use of Synopsis was associated with significantly faster assessment of: overall toxicity history (median 50 vs. 93 seconds, p = 0.0007), highest acute toxicity during treatment (median 19 vs. 40 seconds, p = 0.0002), highest post-treatment toxicity (11 vs. 65 seconds, p < 0.0001), and longitudinal review of a single symptom (8 vs. 61 seconds, p < 0.0001). Among 10 physician survey respondents, 100% reported that Synopsis improved efficiency and 30% reported it led to a change in management. All physicians felt it was important to understand a patient’s toxicity history, but 80% reported that time required with the note-based EHR structure was prohibitive; with use of Synopsis, 90% reported that this task was now feasible. Specific domains most improved included ability to: identify high-grade toxicities (100%), contextualize new symptoms (80%), summarize treatment-related toxicity (80%), navigate in the EHR to a time of high-grade toxicity (60%), evaluate the success of an intervention (30%), and decide whether to discuss a reported new symptom (30%). Conclusions: A centralized toxicity view in the EHR improves clinician efficiency in evaluating longitudinal toxicity data and enhances clinician ability to comprehensively integrate toxicity information into patient care.
Mobile health tool for monitoring cancer treatment complications.
Authors: Sanyal Amit , Heun James M. , Janssen Clemens walter , Sweeney Jessica 
Published: October 2020

297 Background: Side effects after cancer treatment are ubiquitous, seen in up to 98.3% of patients in one Phase III lymphoma trial. Additionally, cancer patients are at a greater risk of mortality from infections such as coronavirus disease 2019 (COVID-19), prompting recommendations for routine screening. Current care delivery model, reliant on self- triaging of symptoms by patients results in delayed management and avoidable emergency room visits and hospitalizations. Technology based symptom monitoring allows early identification of complications, reduces symptom burden, cost of care and enables early detection of relapse. We studied utility of a mobile-health tool for toxicity monitoring and COVID-19 screening. Methods: We developed an application that periodically delivers disease specific toxicity questionnaires to patients following cancer treatment. Based on NCI- PRO-CTCAE form builder, the questions are delivered through SMS or e-mail. Responses crossing pre-specified thresholds are flagged for manual care team follow-up. Patient and staff experience as well as medical interventions are captured. Results: Currently, 68 patients with different malignancies are enrolled. Median age 60 years (range 24-85), 35 males, 31 females. 72.35% patients rated user experience at 4 or higher (1-5 scale, 5 highest). Aggregate provider rating was 3.25 (1-5 scale, 5 highest). Of 639 captured responses, 157 reported fatigue, 145 no symptoms, 57 nausea/vomiting or diarrhea, 52 numbness/tingling and 48 shortness of breath. 76 responses were flagged for nurse follow-up calls. These resulted in 72 successful outpatient symptom management, 2 hospitalizations for neutropenic fever, 1 MRI diagnosis of radiation necrosis and 1 diagnosis of lymphoma progression. 92% of patients received a follow up within one business day. Median time between response recorded and follow up completed was 55 minutes. Of 1299 responses recorded by COVID-19 screening, 1175 reported no symptoms. All positive responses (47 cough, 52 diarrhea, 5 fever and 20 dyspnea) were false positives. Study is ongoing with recent implementation of a distress screening and survivorship modules. Conclusions: Electronic capture of symptoms using connected technology is feasible and can be used to screen cancer patients for treatment related complications as well as pandemic related illnesses.
Toxicity of high-dose methotrexate administration at the Sidney Kimmel Cancer Center (SKCC): A retrospective review to guide establishment of an outpatient treatment program.
Authors: Sokol Kelsey , Yuan Kelley , Fendler Katlin , Burdette Samantha , Galanis Patricia , Piddoubny Maria , Delengowski Anne , Gung Carol , George Mercy , Alpdogan Onder , Martinez-Outschoorn Ubaldo , Porcu Pierluigi , Binder Adam 
Published: October 2020

30 Background: High-dose methotrexate (HDMTX) is administered for the treatment of primary central nervous system (CNS) lymphoma (PCNSL), leptomeningeal metastases, and osteosarcoma, as well as CNS prophylaxis in patients with high-risk lymphoma and leukemia. Treatment is typically administered in an inpatient setting to enable aggressive hydration, urinary alkalinization, and frequent lab monitoring given the risk of acute kidney injury. Multiple pediatric centers have published experiences with outpatient administration of HDMTX. We aim to determine the toxicity rate in adult patients at SKCC receiving HDMTX to identify a population in which to pilot an outpatient HDMTX program. Methods: We performed a retrospective review of all patients receiving inpatient HDMTX at SKCC between January 1, 2018 and October 31, 2019. Results: Seventy-three patients (52% male) with median age of 60 years (range 22-81) received 255 cycles total of HDMTX. Diagnoses include PCNSL/vitreoretinal lymphoma (n=22), diffuse large B-cell lymphoma (n=17), B-cell acute lymphoblastic leukemia (n=16) and other diagnoses (n= 18). Thirty-one cycles were administered as CNS prophylaxis and 224 cycles as treatment, with a median prophylactic dose of 3.5 g/m2 (range 1-3.5) and median treatment dose of 3.5 g/m2 (range 0.25-12). The most common toxicity was acute kidney injury at a median day 3 of the cycle (range 1-7). See the table for details. Conclusions: Acute kidney injury occurred more often in the treatment group compared to prophylaxis group. Of all patients with AKI in the treatment group, 45% had a diagnosis of PCNSL. In the prophylactic group, only 21% of patients (3/14) experienced AKI of which all resolved. Of all AKI events, 90% were Grade 2 and 90% resolved. Based on these results, we plan to pilot an outpatient HDMTX program in patients receiving prophylactic HDMTX to determine its effect on patient quality of life and cost of care. [Table: see text]
Reducing burdens of site feasibility assessments for conducting clinical trials.
Authors: Kurbegov Dax , Hurley Patricia A. , Waterhouse David Michael , Nowakowski Grzegorz S. , Kim Edward S. 
Published: October 2020

300 Background: Current methods to assess site feasibility for industry-funded clinical trials are onerous and delay patient access to novel treatment options and high-quality clinical trials. Industry sponsors and contract research organizations (CROs) often probe for unnecessary and/or duplicative information. These burdens prolong trial start-up times and are a barrier to site participation in oncology trials. The American Society of Clinical Oncology (ASCO) Research Community Forum convened a task force to identify ways to improve the site feasibility assessment process. Methods: Data were collected in 3 steps: 1) survey to assess site burdens, 2) collation of sample feasibility questionnaires (FQs), and 3) stakeholder meeting to discuss potential solutions. The task force then developed recommendations for process improvements and obtained stakeholder feedback through a survey. Results: 113 oncology practices (66 community, 47 academic) reported completing a median 5 FQs and 2 pre-study site visits (PSSVs) per month. FQs took a median 2 hours to complete whereas PSSVs took a median 4 hours to complete. Most considered FQ (81%) and PSSV (91%) content redundant to information previously provided, and FQs similar between different sponsors (86%). The median time from first contact to first patient enrolled was 6 months. The 40 respondents to the stakeholder survey represented 19 academic- and 9 community-based sites, 8 industry sponsors, and 4 CROs. Most preferred a model with a short FQ plus a PSSV when there was not a prior relationship. If there was a prior relationship, either a PSSV or teleconference was preferred. All stakeholders identified time savings, expedited start-up, fewer staff resources, and cost savings as the greatest benefits. The greatest barriers to adoption were buy-in from sponsors and CROs, and insufficient information about site capabilities. Conclusions: Site feasibility assessments for industry-sponsored trials are important to ensure patient safety and access to high quality clinical trials. However, current methods are inefficient and time and resource intensive. This initiative provided insights about challenges for sites and the viability of a fundamental change to site feasibility assessments. ASCO recommendations are forthcoming on improving processes, standardizing and minimizing questions, and using portals that are effective across all trials and clinical research scenarios.
The success of the Rapid Diagnostic Clinic (RDC) detecting new cancers in patients with non-localizing symptoms.
Authors: Sindhar Jan , Martin Sabine , Rahman Loay , Zheng Sifan , Mukadam Yaseen , Ali Sunnyath , Steward Lindsay , Wheeler Daniel , Moss Charlotte L , Jones Geraint , Russell Beth , Van Hemelrijck Mieke , De Michele Luigi , Bhattacharjee Saoirse 
Published: October 2020

303 Background: Rapid Diagnostic Clinics (RDC) are being set up across the UK allow primary care physicians to refer patients with symptoms concerning for cancer that do not fulfil tumour-specific two week wait urgent referral criteria. Guy’s RDC was established to address the high cancer related mortality in our network. There is little data assessing the effectiveness of RDC models is available in a British population. Methods: We evaluated all patients referred to Guy’s RDC pilot scheme between December 2016-June 2019 (n=1,341) to assess the rate and type of cancer diagnosed and clinical outcomes. Results: Of 1341 patients, 96 cancers were diagnoses (7.2%). Most common were lung (16%), haematological (13%) and colorectal (12%). A third were at early stage (I-II) and 40% received radical treatment. Median time to cancer diagnosis 28 days (IQR 15-47) and treatment 56 days (IQR 32-84). 75% of patients were suitable for anti-cancer treatment: surgery (26%), systemic (24%) and radiotherapy (14%). We plan to present updated data on > 2000 patients referred until June 2020. Overall 6% of patients were diagnosed with pre-malignant conditions. Conclusions: RDCs provide a streamlined pathway for complex vague symptoms patients which are challenging for primary care. The 7% rate of cancer diagnosis exceeds many tumour specific urgent pathways which supports the need for rapid tailored diagnostics. The detection of pre-malignant conditions in 6% allows surveillance and intervention to potentially improve long-term outcomes. RDCs are likely to be pivotal in the cancer recovery phase of the COVID-19 pandemic.