bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breast cancer receptor subtypes in East Africa: A systematic review and meta-analysis.
Authors: Popli Pallvi , Gutterman Elane M , Omene Coral Oghenerukevwe , Ganesan Shridar , Marlink Richard 
Published: May 2020

e19074 Background: Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) are determinants of both treatment and mortality for patients with breast cancer (BC). With a mortality to incidence ratio of 0.51, mortality rates for breast cancer in East Africa are among the world’s highest. Building on a meta-analysis of BC receptor subtypes in sub-Saharan Africa (2014) and including all recently available PubMed literature, our meta-analysis aims to investigate the differences among receptor subtype distribution in five East African countries. Methods: Receptor distributions for female samples >30 in all BC articles for Ethiopia, Kenya, Rwanda, Tanzania and Uganda were obtained from PubMed, January 1, 1998 - June 30, 2019. Outcomes were proportions of ER+, PR+, and HER2+ and/or molecular subtypes. Data included study characteristics and mean/median patient age (weighted by observations). Using metaprop for STATA 16, we estimated pooled proportions (ES) with 95% confidence intervals (CI) and assessed I2 statistics for heterogeneity across studies. Results: Among 35 BC studies with receptor data, 21 met criteria. Overall, the weighted mean age was 47.5 years (SD 3.2) and median, 48. For ER+ (18 studies/n=2,875), the overall ES was 0.55 (95% CI 0.47, 0.62), I2 of 94.4%, p<0.001, ranging from 0.62 in Ethiopia (95% CI 0.52, 0.72) to 0.42 in Uganda (95%0.36, 0.49). For HER2+ (18 studies/n=2,689), the overall ES was 0.23 (95% CI 0.20, 0.26), I2 of 70.2%, p<0.001, and ranged from 0.27 in Ethiopia (95% CI 0.18, 0.36) to 0.21 in both Tanzania and Uganda (95% CI 0.13/0.14, 0.28). For triple negative (TN, 15 studies/n=2,510), the overall ES was 0.28 (95% CI 0.23, 0.32), I2 of 84.0%, p<0.001, varying from 0.21 in Ethiopia (95% CI 0.15, 0.27) to 0.46 in Tanzania (95% CI 0.32, 0.60). Conclusions: We found differences between countries, e.g. lower distribution of TN in Ethiopia (21%) compared to Uganda (35%) and Tanzania (46%), and high between-study heterogeneity. Consistent with former studies, ER+, 55%, was the dominant subtype, particularly in Ethiopia, Kenya and Rwanda, indicating the need to prioritize hormonal treatment. Overall rates of HER2 subtype, 23%, approached overall rates of TN, 28%, yet HER2 testing is often not performed due to the cost and unavailability of anti-HER2 therapy, hence this subtype often goes untreated. These findings highlight the benefit of testing and reporting of receptor subtypes at the country level to promote delivery of more effective treatment to reduce the mortality disparity.
Forecasting global essential childhood cancer drug need and cost: An innovative model-based approach.
Authors: Denburg Avram , Empringham Brianna , Hughes Terence , Wagner Anita K. , Ward Zachary J. , Yeh Jennifer , Gupta Sumit , Frazier A. Lindsay 
Published: May 2020

e19078 Background: Childhood cancer outcomes in low-middle income countries (LMICs) have not kept pace with advances in care and survival in high income countries (HICs). A contributing factor to this survival gap is unreliable access to essential cancer drugs. Lack of data on the aggregate need and cost of essential cancer drugs has hampered rational planning and acquisition in many LMICs. Methods: We created a pediatric-specific tool (FORxECAST) that estimates drug quantity and cost for 18 pediatric cancers, customizable to region, regimen, cancer stage distribution, and drug price. We used adapted treatment regimens developed by the International Society of Pediatric Oncology (SIOP), supplemented with input from disease experts, to model treatment approaches reflective of health-system capabilities. FORxECAST incorporates incidence data generated through microsimulation estimates of both diagnosed and undiagnosed (total) cases. Results: We created a pediatric-specific tool (FORxECAST) that estimates drug quantity and cost for 18 pediatric cancers, customizable to region, regimen, cancer stage distribution, and drug price. We used adapted treatment regimens developed by the International Society of Pediatric Oncology (SIOP), supplemented with input from disease experts, to model treatment approaches reflective of health-system capabilities. FORxECAST incorporates incidence data generated through microsimulation estimates of both diagnosed and undiagnosed (total) cases. Conclusions: Our results enable evidence-based forecasting of childhood cancer drug need and cost to inform health system planning in a wide range of countries. The model is adaptable to setting, diagnosis, and treatment approach, allowing decision-makers to generate results specific to their context and needs. Global estimates of essential childhood cancer drug need and cost demonstrate the comparatively small amount of aggregate resources required to treat all cases worldwide, and can help advance innovative procurement strategies with regional and international scale that drive global improvements in childhood cancer drug access.
Distance from a comprehensive cancer center: A poor proxy for serous endometrial cancer outcomes?
Authors: Blackburn Patrick , Gordon Jennifer , Zhang Naixin , Daily Laura Becca , Tillmanns Todd D. 
Published: May 2020

e19084 Background: To compare the relationship between outcomes in serous endometrial cancer patients based on distance from a tertiary referral center in the Southern US. Methods: A retrospective cohort study among all women diagnosed with serous endometrial cancer between 2009 to 2018 was completed at a tertiary referral center in a low socioeconomic Southern US city with a predominately African American population. The primary exposure variable was the distance traveled by the patient to the treatment center. This distance was calculated using Google Maps from the patients’ home addresses to the cancer center. Abstracted data from each patient included patient demographics of home address, BMI at time of first visit, race, transportation method to the cancer center, and presence of primary care provider (PCP). Clinical variables of stage at diagnosis and pathology, treatment, and outcomes were included. Chi square analysis and log-rank analysis were completed. Data was analyzed by SPSS software. Results: In total, 202 patients were living a median distance of 31.4miles (range of 0.9mi to 194mi) from the cancer center. Of this cohort, the median age at time of diagnosis was 67 years old with a median BMI of 31.4kg/m2. The most common stage at diagnosis was stage 1A (26.7%). Using log rank analysis, there was no difference in overall survival when compared based on age, race, BMI and access to transportation. 92% (n=185) of the cohort had immediate access to a transportation method via personal car or family car, the remaining patients relied on other methods of transport. The total distance from treatment center was significant when compared with stage at diagnosis (p=0.011) portending greater stage at diagnosis with further distance. However, this did not correlate to progression free or overall survival (p = 0.83) in the cohort. Patients with a PCP were likely to be diagnosed at an earlier stage (Stage IA or Stage IB) compared to those without a PCP with a p=0.003, mean of 0.93, 95% CI (0.89 – 0.97). Conclusions: Living closer to a cancer center and having a PCP were associated with earlier stage at diagnosis in patients with serous endometrial cancer. Distance from the cancer center did not affect overall survival when adequate transportation methods were available.
Dynamic of time estimation and its relation with levels of distress.
Authors: Conev Nikolay Vladimirov , Ivanova Martina , Dimitrova Eleonora , Yanchev Asen , Donev Ivan 
Published: May 2020

e19091 Background: Our previous study showed a potential relationship between perception of time and level of distress in cancer patients prior to starting chemotherapy. In this study we explored the dynamics of time estimation and the level of distress in cancer patients. Methods: Time estimation and distress were assessed in 262 chemonaïve patients with solid tumors by evaluating each subject’s prospective estimation of how fast one minute passed compared to the actual amount of time passed. The National Comprehensive Cancer Network Distress Thermometer was used at the beginning of the treatment to evaluate the levels of distress. Patients scoring 4 or above were regarded as having high levels of distress. The median value of time estimation was used to stratify the patients into two categories of fast and slow time estimation. After 3 months of treatment time estimation and levels of distress were reevaluated. Results: In total, 125 (response rate 47.7%) patients wanted to be reassessed for the distress level and time estimation. After 3 months of treatment 84 (67.2%) of the patients had not changed their levels of distress, 24 (19.2%) of the patients had low levels of distress, while 17 (13.6%) had high levels distressed. Wilcoxon test did not show a significant change of time estimation and levels of distress before and after 3 months of treatment. We observed a negative weak but significant correlation between the change of distress and change of time estimation (rho = -0.186; p = 0.038). The pattern of the change of time estimation distributions significantly changed according to the reported distress levels at 3rd month. Patients with a fast time estimation at 3rd month had significantly higher levels of distress (4.2±2.6) than patients with a slow time estimation (2.8±2.6). ROC analysis revealed that at the optimal cut-off value of time estimation at 3rd month, high levels of distress can be discriminated with an AUC = 0.64 (95% CI: 0.54-0.73, p = 0.008), a sensitivity of 63.1% and a specificity of 60.1%. Conclusions: Time estimation and its dynamic is a novel potent indicator for high distress in cancer patients.
Prognostic impact of hepatic involvement on spontaneous tumor lysis syndrome in solid tumors.
Authors: Verghese Dhiran , Myint Phyo Thazin , Ali Faisal S. , Sundararajan Nivedita , Gong Zimu , Kozma Kelley Elizabeth 
Published: May 2020

e19098 Background: Tumor lysis syndrome (TLS) is a life-threatening oncological emergency. Spontaneous TLS (STLS) in solid tumors occurring prior to initiation of therapy is a rarely reported entity and has poor outcomes. Little is known about the prognostic factors influencing STLS in solid tumors. Methods: A systematic search of Medline, PubMed, and Embase was conducted to identify reports of patients ≥18 years diagnosed with STLS in solid tumors. Individual case reports and case series were summarized, and descriptive statistics were employed to report clinical outcomes. Fischer exact t test was used for statistical analysis. Results: 63 patients from 61 case reports and one patient from our institution resulted in a total of 64 patients. 53.1% were males with a median age of 56.1 years. The most common solid tumors were of pulmonary origin. 85.9% patients had stage 4 malignancy, 75.0% had hepatic involvement. The most common presenting symptom was abdominal discomfort. The mean serum potassium, phosphorus, uric acid, calcium, lactate dehydrogenase, and creatinine upon presentation were 6.1 mmol/l, 7.5 mg/dl, 16.4 mg/dl, 7.5 mg/dl, 4421.2 IU/L and 3.7 mg/dl, respectively. In addition to intravenous hydration, allopurinol and rasburicase were administered in 48.4% and 42.2% patients. Urinary alkalization and sodium bicarbonate administration were reported in 6.3% and 15.6% patients. 43.8% patients required hemodialysis and 39 patients died (mortality of 60.9%). Patients who underwent hemodialysis had a similar mortality of 60.4%. We assessed liver involvement (primary hepatocellular carcinoma and hepatic metastasis) as a potential prognostic factor. Compared to patients without liver involvement, patients with liver involvement had a higher unadjusted all-cause mortality (70.83% vs 25%; OR 7.29 [95% CI 1.71 - 30.98]; p = 0.006). Conclusions: Hepatic involvement is a potential prognostic factor for STLS in solid tumors and is associated with a grave prognosis. Future large prospective studies are needed to probe into the role of early hemodialysis and to identify other prognostic factors of STLS in solid tumors.
Timing of assessments for PRO measures in advanced RCC clinical trials.
Authors: Agrawal Sundeep , Cheng Joyce , Bhatnagar Vishal , King-Kallimanis Bellinda , Pazdur Richard , Kluetz Paul Gustav 
Published: May 2020

e19101 Background: Efficient and thoughtful collection of PROs in randomized cancer trials is necessary, especially when comparing drugs with differing administration schedules. Assessment timing for PROs can dramatically influence results. We sought to better understand how different assessment schedules affect interpretation of toxicity using PRO data. Methods: We reviewed 3 randomized trials in advanced/metastatic RCC with a control arm of sunitinib administered 4 weeks on/2 weeks off. All 3 trials used FACT Kidney Symptom Index (FKSI-19 or -DRS) and one also used EORTC QLQ-C30. For each trial, we chose patient-reported diarrhea and bone pain due to their strong association with the therapeutic intervention and the disease, respectively. Results: For the first 12 weeks, all trials had PRO assessments at baseline but had differing schedules thereafter. PRO assessment in Trial 1 was every 3 weeks; Trial 2: week 6 and week 12; Trial 3: every 3 weeks on the investigational arm and at weeks 4, 6, 10 and 12 on the sunitinib arm. Notably, all assessments for Trial 2 were after 2-week sunitinib washout while Trials 1 and 3 had assessments before and after washout. The table shows the percentage of patients who experienced any worsening from baseline in diarrhea and bone pain in the first 2 assessments. In each trial, more patients had worsening following periods of treatment versus washout on the sunitinib arm, with no such fluctuation on the non-sunitinib arms. The pattern was more apparent for diarrhea (treatment-related) than for bone pain (disease-related). Conclusions: Patients’ recall of symptoms may vary depending on the timing of PRO assessments in relation to drug administration and may be more prominent with respect to treatment-related symptoms, as disease-related symptoms are less impacted by drug toxicity and washout. Clinical protocols should carefully consider PRO assessment timing in relation to drug administration to improve interpretation of toxicity. Higher fidelity PRO data can be obtained with weekly collection of symptoms during the first few months of cancer clinical trials. [Table: see text]
Temporal trends in inpatient outcomes and resource utilization in patients with tumor lysis syndrome (TLS) with solid and hematologic cancers: A nationwide analysis.
Authors: Moturi Krishna Rekha , Lingamaneni Prasanth , Baral Binav , Vohra Ishaan , Banskota Shristi Upadhyay , Gupta Shweta 
Published: May 2020

e19102 Background: Tumor lysis syndrome (TLS) is a well-recognized complication in cancer patients with high tumor burden receiving chemotherapy and is associated with increased morbidity and mortality. Our study specifically looks at longitudinal trends in outcomes and healthcare utilization in TLS patients over time. Methods: Adult patients with TLS admitted between 2012-2017 were identified from the Nationwide Inpatient Sample database. Statistical tests for trends of outcomes (including mortality and Acute Kidney Injury (AKI)) and resource utilization across six years were performed. Multivariable logistic regression was used to evaluate risk factors for mortality in TLS. Results: A total of 57,760 patients met inclusion criteria, with 15.2% having Solid Tumors (ST) and rest hematological cancers (HC). Patients with ST were predominantly older (mean age 60.7 vs 56.4 years, p < 0.0001) and female (44.6% vs 35.2%, p < 0.0001). ST patients had higher mortality (32.3% vs 19.1, p < 0.0001) and AKI (68.6% vs 59.3%, p < 0.0001); but shorter hospitals stay (10.5 vs 15.8 days, p < 0.0001) and lower hospital charges ($34k vs $59k, p < 0.0001). Multivariable analysis showed increased inpatient mortality with ST compared to HC (OR 1.54, 95% CI 1.35-1.76, p < 0.001). Although mortality in ST non-significantly decreased from 36.2% to 28.9% over time, it remained constant in HC. Rate of AKI increased significantly in both cohorts. There were no significant temporal changes in hospital charges in either group, although those with HC were noted to have a decrease in length of stay, from 16.8 to 15.6 days (p = 0.02) over time. Trends of outcomes and resource utilization in TLS. Conclusions: TLS in ST has worse prognosis than HC, although mortality has improved over years. However, inpatient mortality remains largely unchanged in HC. Despite therapeutic advances, [Table: see text]
Variations in objective knowledge among decision-support persons of patients with early stage breast cancer.
Authors: Wytiaz Victoria A , Veenstra Christine M , Hawley Sarah T. 
Published: May 2020

e19110 Background: Patients with breast cancer face complex decisions regarding treatment options, and frequently involve family, friends, and other decision supporters in decision-making. A high-quality decision is one that is both informed and values-concordant. While much has been done to evaluate the quality of decision-making among patients, very little is known about how decision supporters fit within that framework. Thus, we sought to understand variations in objective knowledge among decision supporters. Methods: Patients with stage 0-II breast cancer reported to Georgia and LA SEER registries in 2014-15 and their key decision support person (DSP) were surveyed separately. DSPs were asked 4 objective knowledge questions regarding breast cancer treatment with responses dichotomized into high/low knowledge. Bivariate analyses and multivariable regression models were used to assess associations between DSP knowledge and important DSP characteristics (type of DSP, age, race, education), level of DSP engagement in 3 domains of patients’ decision-making (feeling informed about decisions, extent of and satisfaction with their involvement in decisions, and being aware of patients’ values/preferences), and patient clinical factors (stage, chemotherapy receipt, radiation receipt, type of surgery). Results: 2502 patients (68% RR) and 1203 eligible DSPs (70% RR) responded. Most DSPs were husbands or daughters. 21% were Latino, 17% were black, 20% had <high school education. Overall,53% DSPs had high objective knowledge. DSPs with high knowledge were more likely to be non-Black, non-Spanish-speaking Latinos, have a higher level of education, and report high engagement in the domains of satisfaction with their involvement in patients’ decision-making and awareness of patients’ values/preferences (all p < 0.05). After adjustment, high objective knowledge among DSPs was associated a higher level of education (OR = 2.44; 95% CI = 1.67-3.57) and high awareness of patients’ values/preferences (OR = 1.40; 95% CI = 1.06-1.84). Conclusions: Objective knowledge about breast cancer treatment was varied among DSPs of patients with breast cancer. Highly engaged DSPs (aware and satisfied) were more likely to have high knowledge, suggesting that involving DSPs may be an untapped mechanism for improving patients’ understanding of treatment options. These finding suggest that DSPs can play a role in improving decision quality in patients, and that interventions focused on decision-making may benefit from modules directed to DSPs as well as patients.
Missing data in breast cancer: Relationship with survival in national databases.
Authors: Plichta Jennifer Kay , Rushing Christel N. , Lewis Holly C. , Blazer Dan G. , Hyslop Terry , Greenup Rachel Adams 
Published: May 2020

e19114 Background: National cancer registries are valuable tools used to analyze patterns of care and clinical oncology outcomes; yet, patients with missing data may impact the accuracy and generalizability of these data. We sought to evaluate the association between missing data and overall survival (OS). Methods: Using the NCDB and SEER, we compared data missingness among patients diagnosed with invasive breast cancer from 2010-2014. Key variables included: demographic variables (age, race, ethnicity, insurance, education, income), tumor variables (grade, ER, PR, HER2, TNM stage), and treatment variables (surgery in both databases; chemotherapy and radiation in NCDB). OS was compared between those with and without missing data via Cox proportional hazards models. Results: Overall, 775,996 patients in the NCDB and 263,016 in SEER were identified; missingness of at least 1 key variable was 29% and 13%, respectively. Of those, the majority were missing a tumor variable (NCDB 80%; SEER 88%), while demographic and treatment variables were missing less often. When compared to patients with complete data, missingness was associated with a greater risk of death; NCDB 17% vs. 14% (HR 1.23, 99% CI 1.21-1.25) and SEER 27% vs 14% (HR 2.11, 99% CI 2.05-2.18). Rate of death was similar whether the patient was missing 1 or ≥2 variables. When stratified by the type of missing variable, differences in OS between those with and without missing data in the NCDB were small. In SEER, reductions in OS were largest for those missing tumor variables (HR 2.26, 99% CI 2.19-2.33) or surgery data (HR 3.84, 99% CI 3.32-4.45). Among the tumor variables specifically, few clinically meaningful differences in OS were noted in the NCDB, while the most significant differences in SEER were noted in T and N stage (table). Conclusions: Missingness of select variables is associated with a worse OS and is not uncommon within large national cancer registries. Therefore, researchers must use caution when choosing inclusion/exclusion criteria for outcomes studies. Future research is needed to elucidate which patients are most often missing data and why OS differences are observed. [Table: see text]