bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency room presentation of lung cancer as a highly practical prognostic marker for consideration in clinical trials: A SEER database analysis.
Authors: Mushtaq Rao Rashid , Yekkaluri Sruthi , Meyer Elisabeth , Camidge D. Ross 
Published: May 2020

e19032 Background: Multiple factors influencing lung cancer prognosis could be used for stratification in randomized intervention trials which are either observer-dependent (performance status) or poorly available (education/comorbidity index). In this study we explored the independence of ER presentation of lung cancer (an objective variable) as a prognostic factor. Methods: We performed a study using patients from the Surveillance, Epidemiology, and End Results-Medicare linked database, aged 66 years or older and diagnosed with lung cancer between 2007 and 2015. ER presentation was defined as ER visit ≤30 days prior to the earliest diagnostic procedure. Factors associated with ER versus non-ER presentation and the impact of ER presentation on overall survival (OS) and Cancer specific survival (CSS) were assessed. Results: Between 2007 and 2015, a total of 75,798 lung cancer patients met study criteria. 37% of small cell lung cancer (SCLC) and 28% non-small cell lung cancer (NSCLC) patients had ER presentation. For both histologies, in univariate Chi-Square analysis ER presentation was affected (p < 0.05) by sex, race, marital status, census tract poverty and education levels, number of comorbidities, geographic region, and cancer stage, but not by age (except with NSCLC) or rural/urban commute. Multivariable Logistic Regression showed that for both histologies, stage IV, Black or Hispanic race/ethnicity, East or mid-West region, ≥2 comorbidities, unmarried, and tract poverty level ≥ median were independent risk factors associated with ER presentation (odds ratio > 1). For NSCLC, year of diagnosis ≥2009, female, age ≥75, South region, tract education level > median; for SCLC, year of diagnosis ≥2012 and age 70-74 were also significantly associated with ER-presentation. ER versus non-ER presentation was associated with lower 1-yr OS in NSCLC (43% vs 61% HR 1.79, 95% CI 1.68, 1.77; p < 0.0001) and SCLC (33% vs 43% HR 1.32, 95% CI 1.25, 1.40; p < 0.0001). After adjusting for histology, year of diagnosis, age, sex, race, marital status, region, poverty level, education level, number of comorbidities, and stage in a multivariable Cox model, ER presentation remained an independent poor prognostic marker (HR for OS 1.34, 95% CI 1.31, 1.37; p < 0.0001; HR for CSS 1.32, 95% CI 1.29, 1.36; p < 0.0001). Conclusions: ER presentation of lung cancer is an independent, objective, highly practical poor prognostic risk factor which should be considered for patient stratification and data analyses within interventional clinical trials.
Outcomes in minority patients (pt) with aggressive B cell lymphoma (BCL) if optimally managed with equal access to care and nurse navigation (NN).
Authors: Hu Bei , Chen Tommy , Boselli Danielle , Pye Lisa , Bose Rupali , Raghavan Derek , Symanowski James Thomas , Blackley Kris , Moyo Tamara Kay , Jacobs Ryan , Park Steven , Soni Amy , Avalos Belinda , Copelan Edward Alan , Ghosh Nilanjan 
Published: May 2020

e19040 Background: Aggressive BCL is curable but previous studies have shown that minorities have inferior survival, partly due to socioeconomic barriers and poor access to care. NN programs are designed to reduce barriers to care via various methods. We present disease characteristics, treatment, and outcomes of Caucasian (C) & non-Caucasian (NC) pts with aggressive BCL at Levine Cancer Institute which has an active NN program. Methods: We collected demographic, insurance, disease characteristics, treatment, and outcomes for pts with aggressive BCL [diffuse large B cell lymphoma (DLBCL), primary mediastinal B cell lymphoma (PMBCL), or high grade B cell lymphoma (HGL)] between Jan 2016 and Jun 2019. Race (C or NC) was self-reported. NN encounters were characterized as low intensity (basic needs) or high (moderate/high needs). OS and PFS were calculated using Kaplan Meier. Demographics were compared using Fisher's Exact tests. Results: 204 pts (186 = DLBCL, 14 = PMBCL, 4 = HGL) were included (NC = 47; C = 157). NC were younger at diagnosis (median age 56 vs 62 yrs, p = 0.03) and more likely to be uninsured/Medicaid (26% vs 4%, p < 0.0001). There were no significant differences in prognostic scores (44% vs 50% R-IPI score 3-5, p = 0.5), incidence of double hit (11% vs 13%, p = 0.8), frontline rituximab/anthracycline containing chemotherapy (98% vs 96%, p = 0.9), and incidence of relapsed/refractory (R/R) disease (40% vs 37%, p = 0.7) for NC compared to C. For R/R BCL, similar % of pts underwent hematopoietic stem cell transplant (SCT) (32% NC vs 28% C, p = 0.8) or CAR-T cell therapy (16% NC vs 19% C, p = 0.9). Enrollment in clinical trials was comparable (17% NC vs 14% C, p = 0.6). The % of pts receiving NN was similar (81% NC, 87% C, p = 0.4) but NC had higher intensity NN encounters (42% vs 21%, p = 0.01). With median follow up of 35 mo, OS and PFS were comparable between both groups. The 2 yr OS was 81% for NC and 76% for C, p = 0.3; 2 yr PFS was 62% for NC and 64% for C, p = 0.8. Conclusions: We show equivalent survival between Caucasian and non-Caucasian pts with aggressive BCL. Disease biology and treatment patterns--including access to SCT, CAR-T and clinical trials--were similar in both groups. Differences in insurance coverage favored Caucasians. Similar proportion of pts in both groups received nurse navigation, but non-Caucasian pts had higher intensity navigation needs. Providing equal access to care and availability of an active nurse navigation program may overcome racial heath disparities. This study has implications for national health policy.
The effect of locality of residence (LOR) and socioeconomic status (SES) on mortality in patients with squamous cell carcinoma of the head and neck (HNSCC): 20-year experience at the UPMC Hillman Cancer Center.
Authors: Taylor Janielle , Shuai Yongli , Robertson Linda , Normolle Daniel Paul , Ferris Robert L , Bear Todd , Nilsen Marci Lee , Johnson Jonas T. , Kubik Mark , Sridharan Shaum , Duvvuri Umamaheswar , Wang Eric , Skinner Heath Devin , Clump David Anthony , Ohr James , Snyderman Carl , Chiosea Simion I. , Gish-Johnson Rachelle , Kim Seungwon , Zandberg Dan Paul 
Published: May 2020

e19043 Background: As cancer centers expand, evaluation of potential disparities in outcomes amongst the catchment area is critically important. We examined the effect of LOR and SES on overall survival (OS) in HNSCC patients treated at HCC, which spans 29 counties in western Pennsylvania with diverse socioeconomic profiles across urban and rural localities. Methods: Retrospective review included patients with primary HNSCC (excluding M1 and recurrent disease) treated at HCC 1997-2018. Using Rural-Urban Commuting Area codes, LOR was classified as urban/suburban or rural according to ZIP code. SES was defined by medium income level (low, moderate (Mod), middle (Mid), Upper) via Federal Financial Institutions Examination Council geocoded census tract data. Kaplan-Meier methods and Cox regression models were used to evaluate OS. Results: 3512 patients were identified. Median age was 61, 72.7% male, 93.2% White, 18% HPV +, 75.5% urban/suburban, and by SES: 4% Low, 21% Mod, 46% Mid, and 19% Upper. Primary site included 35.2% oral cavity, 28.4% oropharynx, 28.1% larynx, 8.3% other, stage was majority III/IVa (61%), 66% had surgery and 54% received multimodality treatment (tx). While median OS differed significantly by race (Black: 5.8 vs. White: 7.3 years, p = 0.0457) and SES (Low: 4.1 vs. Mod: 5.3 vs. Mid: 7.3 vs. Upper: 9.1 years, p < 0.0001), there was no difference by LOR (rural: 7.7 vs. urban/suburban: 7.2 years, p = 0.99). Multivariable Cox Regression showed lower SES was associated with a higher risk of death [(Low vs. Upper, HR: 1.416, 95% CI: 1.023-1.959) (Mod vs. Upper, HR:1.443, 95% CI: 1.214 – 1.716), p = 0.0004], adjusting for LOR and factors associated with OS in univariate analysis (age, smoking status, primary site, staging, tx, HPV status, race, and enrollment on clinical trial). The effect of LOR, race, and enrollment on clinical trial were not significant in multivariate analysis. Conclusions: SES was independently associated with OS in HNSCC patients treated at HCC, while LOR was not associated with OS. The lack of difference by LOR may be partially explained by HCC’s efforts to increase access to care throughout the catchment area by establishing community sites. However, a focus on improving outcomes for lower SES HNSCC patients is needed.
Identification of transgender people with cancer in electronic health records (EHR): Recommendations based on CancerLinQ observations.
Authors: Alpert Ash , Bruinooge Suanna S. , Dizon Don S. , Koronkowski Becky , Garrett-Mayer Elizabeth , Meersman Stephen C. , Miller Robert S. , Potter Danielle , Komatsoulis George Anthony 
Published: May 2020

e19046 Background: Data regarding people who are gender minorities are not well-captured in oncology practices or large cohorts. Given this, collection of cancer prevalence and outcomes data, which are necessary to understand disparities in this population, are significantly hampered. Real-world data may be the most readily available source to explore outcomes in transgender populations. A database of EHR data on people with cancer, CancerLinQ is housed by the American Society of Clinical Oncology and collected from nation-wide practices and multiple EHRs. Methods: In order to identify people with cancer who may be transgender within CancerLinQ, we used three criteria: 1. ICD 9/10 diagnosis (Dx) code indicating likely transgender or non-binary gender conforming status 2. Male gender and Dx of cervical, endometrial, ovarian, or Fallopian tube cancers 3. Female gender and Dx of prostate, testicular, or penile cancers . We reviewed medical records for gender, cancer diagnosis, Dx indicating transgender identity and surgical history of transition-related surgeries, in other words surgeries that align bodies with identities and constructed a de-identified dataset of people who met one of the three criteria listed above. People without evidence of transgender identity were assigned as: (1) likely Dx error, because the person had either (a) no cancer, (b) an alternate cancer Dx consistent with sex assigned at birth, or (c) a cancer not listed in the above criteria (e.g. lung); or (2) likely error in gender data, if the cancer Dx was confirmed, but gender data was not; or (3) unknown. Results: Of ~1.3 million records in CancerLinQ at time of case selection, 557 matched inclusion criteria and 242 were abstracted. 76% of patients with ICD9/10 gender related Dx codes had evidence confirming transgender identity. By contrast, only 2% and 3% of the people identified by criteria 2 and 3 had evidence of transgender identity, respectively. Conclusions: Given the need for data regarding transgender people with cancer and the deficiencies of current data resources, a national concerted effort is needed to broaden terminology in EHRs to include whether people are transgender or not as routine and required data elements, provided by patients at their discretion. [Table: see text]
Impact of age on racial disparity in early stage breast cancer in the United States.
Authors: Bhandari Shruti , Kumar Rohit , Ngo Phuong , Mudra Sarah , Murray Drew Carl Drennan , Riley Elizabeth Carloss , Boone Stephanie D. 
Published: May 2020

e19058 Background: Racial disparities persists in women with early stage breast cancer and is most pronounced in Black (B) compared to White (W) women even when controlled for stage and biological subtype. Little is known about the impact of age on racial disparities. Our study evaluates the magnitude of a racial disparity in mortality across age strata in a real-world population. Methods: We identified stage I-III female breast cancer patients between 2010 – 2015 from the National Cancer Database. Hazard ratios (HR) and 95% Confidence Intervals (CI) for all-cause mortality were estimated using multivariable Cox Proportional Hazards regression, adjusted for clinical and demographic factors. The mortality risk for B and Other (O) race was compared to W across four age groups. To determine the significance in excess risk of mortality, the magnitude of disparity of each age group was compared to the > 60y age group. Results: A total of 679,327 patients were included. W comprised the largest percentage across all age groups. However, the percentage of W increased with age, while the percentage of B decreased with age (p < 0.001). The risk of mortality was significantly higher for B relative to W across all age groups ≤60y. When compared to > 60y, the magnitude of effect of age on risk of dying was significantly different (p < 0.0001) (Table). Conversely, the risk of mortality was significantly reduced for O race compared to W, with similar magnitude of effect across all ages. Conclusions: Even after adjusting for known risk factors of racial disparity such as insurance, biologic subtype and stage, the B to W racial disparity in mortality decreased with age (most pronounced in younger age) and appeared to diminish among women > 60 years of age. In contrast, the risk of dying in O race remained constant. Reasons are unclear and may be due to unmeasured socioecomomic or biologic factors that cannot be controlled for in this dataset. Regardless, identifying factors associated with worsened outcomes in younger age groups in B women should be the direction of future studies. [Table: see text]
Socioeconomic status, race, and mortality disparities in insured patients in southern California.
Authors: Cooper Robert Michael , Haque Reina , Schottinger Joanne E. 
Published: May 2020

e19060 Background: One known factor related to increased mortality is lack of health insurance coverage. To eliminate this variable we evaluated overall mortality by socioeconomic status (SES) in an insured southern California population diagnosed with cancer accounting for confounding factors including race/ethnicity. Methods: We identified adults diagnosed with eight common cancers from 2009-2014 from the California Cancer Registry and followed them through 2017. We calculated person-year mortality rates by SES and race/ethnicity. Adjusted hazard ratios for the association between all-cause mortality and SES were estimated using Cox proportional hazards models accounting for covariates (race/ethnicity, demographics, stage, treatments). Results: A total of 164,197 adults were diagnosed with cancers of the breast, prostate, lung, colon, melanoma, uterus, kidney and bladder; total of numbers of deaths was N=41,727. Compared to subjects in the highest SES quintile, we found an increased overall mortality risk in each of the lower SES quintiles. In multivariable models, mortality risk was 16% to 37% greater in the lower SES groups versus the highest SES group. Conclusions: After multivariable adjustment that accounted for race/ethnicity, cancer treatments and tumor factors, insured individuals in lower SES groups had a significantly higher overall mortality risk compared those in the highest SES group. [Table: see text]
Implementation of a triage system in the Alerta Rosa breast cancer navigation program.
Authors: Villarreal-Garza Cynthia , Tamez-Salazar Jaime , Mireles-Aguilar Teresa , De la Garza-Ramos Cynthia , García-García Marisol , Ferrigno Ana Sofia , Platas Alejandra 
Published: May 2020

e19064 Background: Alerta Rosa is a navigation program in Nuevo Leon, Mexico that aims to reduce delays in breast cancer (BC) diagnosis and treatment initiation irrespective of healthcare coverage. Via a call center, a navigator registers each patient’s initial concern and schedules a medical evaluation. This study aimed to assess the implementation of a triage system to guide appointment prioritization for undiagnosed BC patients with abnormal breast findings or imaging studies. Methods: Women that contacted Alerta Rosa were stratified according to their clinical characteristics into three priority groups. Asymptomatic women seeking check-up information were classified as low-priority (“Green”), those with nonspecific symptoms (e.g. mastalgia) or indeterminate image studies (BIRADS 0) as intermediate-priority (“Yellow”), and patients with suspicious symptoms (i.e. palpable mass, nipple retraction or bloody discharge), abnormal image studies (BIRADS 3-5) or an established BC diagnosis as high-priority (“Red”) for an appointment. The triage system’s ability to detect undiagnosed BC was evaluated against the number of patients per category in whom BC was later confirmed. Differences in time from initial contact to first medical evaluation were explored with an independent t-test. Results: From December 2017 to 2019, 561 women with a median age of 44 years (range: 8-89) contacted Alerta Rosa. 369 (66%) reported breast symptoms, 92 (16%) sought check-up information, 68 (12%) had an indeterminate/abnormal image study and 32 (6%) had received a BC diagnosis and wanted a second opinion. Accordingly, 16% of patients were classified as “Green”, 25% “Yellow” and 59% “Red”. The median time from stratification to medical evaluation was 4 days for the “Red” group and 7 days for those in other categories ( p= 0.003). A total of 558 appointments were scheduled, of which 441 (79%) were attended. Excluding those who had received a prior BC diagnosis, 20/299 patients from the “Red” group had BC confirmed (6.7%) compared to 1/138 patient from the “Yellow” (0.7%) and none from the “Green” categories. Therefore, the “Red” category achieved a sensitivity of 95.2% (CI95%: 76.2-99.9%) and specificity of 53.8% (CI95%: 49.3-58.3%) for BC. Conclusions: The triage system adequately identified women with different probabilities of having BC. Thus, the implementation of a stratification system could help identify high risk patients in limited-resource settings where screening programs are ineffective and efforts to prioritize access to medical attention is crucial to achieve early-stage diagnoses.
Beyond patient-level barriers: Evaluation of rural residency and area-level deprivation and clinical trial (CT) participation.
Authors: Unger Joseph M. , Moseley Anna , Osarogiagbon Raymond U. , Doolittle Gary C. , Hershman Dawn L. 
Published: May 2020

e19068 Background: Residents of rural and socioeconomically deprived areas have worse cancer outcomes and are less likely to participate in CTs. It is unknown whether these area-level attributes predict CT participation after accounting for individual sociodemographic variables. Methods: We combined data from two SWOG national survey studies. S0316, a multi-center prospective survey, was combined with data from a large web-based survey. Both studies examined CT treatment decision making from diagnosis in patients with common cancers. Zip codes of residences were classified as rural or urban using Rural-Urban Continuum Codes (urban, 1-3, vs. rural, 4-9) and a 3-level ordinal variable (urban, 1-3, vs. rural, 4-7, vs. very rural, 8-9). We identified socioeconomically deprived areas (SDAs) as those with an Area Deprivation Index (ADI) in the upper quartile. We also examined areas by ADI quartile. Multivariable logistic regression was used to evaluate the association of rural residency and area-level socioeconomic deprivation with CT participation after adjusting for important individual-level factors (age, sex, race/ethnicity, income, and education), stratified by study and cancer type. Results: Among 7080 patients, 1299 (18.5%) were from rural areas, 653 (9.4%) were from SDAs; and 715 (10.1%) participated in a CT. Patients had breast (56.1%), prostate (21.8%), lung (13.6%), and colorectal (8.4%) cancer. In univariate analysis, rural patients were 23% less likely to participate in a CT (OR=0.77, 95% CI: 0.62-0.95, p=.016); in multivariate analysis, results were similar (OR=0.80, 95% CI: 0.64-0.99, p=.037). Very rural residents were 34% less likely to participate than urban patients (OR=0.66, 95% CI, 0.55-0.80, ordinal p=.031). There was no statistically significant association between residence in SDAs and CT participation (p>.30). Rural patients were more likely to have >1 comorbid conditions (45.4% vs. 39.5%, p=.001), to be concerned about how to pay for their care (40.6% vs. 32.4%, p<.0001), and to travel farther for care (median 50.0 vs. 12.0 miles, p<.0001). Conclusions: Our findings are the first to show that rural residents are less likely to participate in CTs even after accounting for confounding individual factors. These results agree with prior observations that rural patients must travel longer distances for care, including for CT care. Reducing the travel burden for rural cancer patients could improve their CT participation and the generalizability of CT results to all patients.
Prostate cancer screening patterns among LGBT populations.
Authors: Ma Sung Jun , Oladeru Oluwadamilola Temilade , Miccio Joseph , Wang Katy , Attwood Kristopher , Singh Anurag K , Haas-Kogan Daphne A. , Neira Paula M 
Published: May 2020

e19077 Background: More than 10 million Americans identify themselves as lesbian, gay, bisexual, and transgender (LGBT), and the majority of male-to-female (MTF) transgender individuals still have prostates even after surgical transitions. Guidelines on prostate specific antigen (PSA) screening for LGBT populations are limited, and informed and shared decision making are encouraged by various organizations. However, patterns of care for PSA screening in LGBT populations remains unclear. To address this knowledge gap, we conducted a cross sectional study to evaluate self-reported PSA screening and decision making among LGBT populations. Methods: The Behavioral Risk Factor Surveillance System database was queried for LGBT adults from 2014-2016 and 2018. Those with prior prostate cancer were excluded. Multivariable logistic regression was performed to evaluate the association of LGBT status with PSA screening, informed and shared decision making, after adjusting for demographic characteristics and survey weights. Results: A total of 164,370 participants were eligible for PSA screening (n = 156,548 for cisgender [CG]+straight, n = 156 for MTF+straight, n = 33 for MTF+gay, n = 52 for MTF+bisexual, n = 51 for MTF+other sexual orientation [SO], n = 3354 for CG+gay, n = 1641 for CG+bisexual, n = 2535 for CG+other SO), representing a weighted estimate of 1.2 million LGBT populations. When compared to CG+straight, CG+gay/bisexual cohorts were more likely to undergo PSA screening within the past 2 years (CG+gay: OR 1.08, p < 0.001; CG+bisexual: OR 1.06, p < 0.001), have ever received PSA screening (CG+gay: OR 1.30, p < 0.001; CG+bisexual: OR 1.12, p < 0.001), and be recommended for PSA screening by their physicians (CG+gay and bisexual: OR 1.16, p < 0.001). All other cohorts were less likely to do so (all OR < 1, p < 0.05). MTF+gay and CG+gay participants were more likely to make informed decision (MTF+gay: OR 3.13, p < 0.001; CG+gay: OR 1.09, p < 0.001), while all other cohorts were less likely to do so (all OR < 1, p < 0.05). CG+gay participants were also more likely to share decision (OR 2.51, p < 0.001), while there were no associations for all other cohorts (all p > 0.05). Conclusions: Select gay populations were more likely to undertake PSA screening recommended by their physicians and participate in informed and shared decision making. However, other LGBT populations were less likely to make informed decisions, and transgender participants were less likely to undergo PSA screening. Further research efforts are needed to improve informed and shared decision making for PSA screening in such underserved population.