bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adjuvant chemotherapy (AC) initiation and early discontinuation in elderly patients (EPs) with stage III colon cancer (CC).
Authors: Ko Jenny J , Kennecke Hagen F. , Lim Howard John , Gill Sharlene , Woods Ryan , Speers Caroline , Cheung Winson Y. 
Published: March 2020

6014 Background: Research suggests that EPs with cancer are commonly undertreated, but the precise reasons for this observation are unclear. Our aims were to 1) evaluate the impact of advanced age on AC use (none vs capecitabine vs FOLFOX) for stage III CC, 2) determine the specific reasons for selecting and discontinuing a particular regimen, and 3) examine if the effect of AC on outcomes is modified by age. Methods: Patients diagnosed with stage III CC from 2006 to 2008 and referred to any 1 of 5 cancer centers in British Columbia, Canada were identified. Descriptive statistics were used to summarize treatment patterns in young patients (YPs) aged <70 vs EPs aged >/=70 years. Logistic regression was used to evaluate the association between AC and cancer-specific survival (CSS) in YPs and EPs. Results: We identified 810 patients: 51% men, 52% YPs and 48% EPs, and 74% received AC in the entire cohort. When compared to YPs, EPs had worse ECOG and more comorbidities (both p<0.01). EPs were less likely than YPs to receive AC (57 vs 91%, p<0.01). Frequent reasons for no treatment included age, comorbidities and perceived minimal benefit from AC. Among those treated with AC, EPs were less likely to receive FOLFOX (32 vs 74%, p<0.01) in favor of capecitabine due to patient preference, age and comorbidities. Once started on AC, EPs had similar rates of early treatment discontinuation as YPs (70 vs 62%, p=0.08). Reasons for early discontinuation were comparable between EPs and YPs (Table). Receipt of either FOLFOX or capecitabine was correlated with improved CSS, compared to surgery alone. Age did not modify CSS, irrespective of AC choice (interaction p for capecitabine and age=0.26; interaction p for FOLFOX and age=0.40). Conclusions: EPs with stage III CC frequently received either no adjuvant treatment or capecitabine monotherapy due to advanced age and comorbidities. The treatment effect of AC on CSS is similar across age groups, with comparable side effects and rates of discontinuation between EPs and YPs. AC should not be withheld from CC patients based on advanced age alone. [Table: see text]
Do patients with advanced-stage non-small cell lung cancer (AS NSCLC) live longer if managed within a clinical trial setting?
Authors: Abu Hejleh Taher , Chrischilles Elizabeth A. , Halfdanarson Thorvardur Ragnar , Pendergast Jane F , Jiang Dingfeng , Smith Carmen J. , Porter Aaron T. , Wallace Robert B ,   Cancer Care Outcomes Research and Surveillance Consortium (CanCORS)
Published: March 2020

6034 Background: Treatment outcomes of AS NSCLC (stages IIIB and IV) are poor. There is an argument that participation in a clinical trial (CT) may confer survival benefit, probably, through enhancing quality of care. In this study, we explore the survival outcomes and perceived care quality for AS NSCLC patients (pts) treated within vs outside a CT. Methods: Data were obtained from surveys of newly diagnosed AS NSCLC pts studied by the Cancer Care Outcomes Research and Surveillance Consortium (CanCORS), a large cohort of pts across the United States. Pts who did not complete the baseline survey were excluded as this was associated with worse performance status (PS). Baseline characteristics according to CT participation were determined. Association between CT enrollment and survival was explored utilizing univariate and multivariate survival analysis after adjusting for age, comorbidities and self-reported PS. Results: Of 815 AS NSCLC pts, 56 (7%) were enrolled on a CT. Chemotherapy trials comprised 67% of all trials. Of the 815 pts, 697 (86%) died. Median survival for pts within vs outside a CT was 62 vs 64 months. Neither age, comorbidities nor recalled PS differed significantly between pts within vs outside a CT (P=0.2085, 0.5818 and 0.1678 respectively). On the multivariate survival model, CT enrollment did not correlate with longer survival (P=0.8811) and only presence of comorbidities was associated with worse survival (P=0.0021). Comparing pts according to CT enrollment, there was no significant difference in symptom management, receiving hospice care (P=0.606), death location (P=0.2018), or following pts’ wishes (P=0.8321). However, perception of the overall cancer care quality was greater among CT enrollees (P=0.0171). Conclusions: Management of AS NSCLC pts within a CT setting conveyed a perception of superior care that did not translate into survival benefit after adjusting for differences in age, comorbidities, and self-reported PS. These findings suggest that providing cancer care within a CT should not imply a survival benefit when counseling AS NSCLC pts about entering CTs.
Association of increases in quality of care with the NCI Community Cancer Center Program (NCCCP) pilot.
Authors: Halpern Michael T. , Spain Pamela , Holden Debra J. , Stewart Andrew , McNamara Erica J. , Gay E. Greer , Clauser Steven B. , Prabhu Das Irene 
Published: March 2020

6046 Background: The NCCCP pilot is an initiative designed to enhance research and improve cancer care at community hospitals. As part of a multi-method evaluation of this pilot, we assessed changes in quality of care among the 16 pilot NCCCP hospitals over time (before vs. after program initiation) and in comparison to a group of 25 similar hospitals that did not participate in the NCCCP. Methods: We compared changes in 5 NQF-approved quality of care measures (3 for breast cancer, 2 for colon cancer) from 2006/07 (before NCCCP initiation) vs. 2008/09/10 (post-initiation) for NCCCP and comparison group hospitals. Data were collected from all study hospitals using the Commission on Cancer’s Rapid Quality Reporting System, which allowed near real-time tracking of quality of care process measures. Results: Analyses included 18,608 breast cancer and 7,031 colon cancer patients. Patient-level concordance rates for all 5 quality of care measures increased significantly among both NCCCP and comparison group hospitals. The change (from baseline to post-NCCCP) in quality of care among NCCCP hospitals was significantly greater than the change among comparison group hospitals for two measures: radiation therapy following breast conserving surgery (RT-BCS) and hormonal therapy for women with hormone receptor positive breast cancer (HT). For the RT-BCS measure, NCCCP patients from underserved populations also experienced significantly greater changes in concordance than did corresponding populations from comparison group hospitals. In multivariate regression analyses controlling for patient characteristics, the change for the HT measure among NCCCP hospitals was significantly greater than that among comparison group hospitals. Conclusions: While both NCCCP and comparison group hospitals showed improved quality of care, participation in the NCCCP was associated with significantly greater improvements for a subset of measures. Including a separate comparison hospital group was critical for assessing changes associated with NCCCP participation while controlling for broader U.S. trends in improved quality of care. Future work will examine how hospital networks may have facilitated improvements in quality of care.
Geographic and network analysis of oncology trials: Portfolio assessment of ClinicalTrials.gov.
Authors: Cheng Steven Kunyuan , Hirsch Bradford Richard , Califf Robert M , Tasneem Asba , Schulman Kevin A. , Abernethy Amy Pickar , Dilts David M. 
Published: March 2020

6047 Background: Increasing complexity and specificity of cancer trials (CT) necessitates collaboration across the CT network to optimize research efforts. The relationship among CT sites and networks provide unique insights into improving coordination and accrual. Methods: 5971 interventional CTs registered between 2007 and 2010 were aggregated by trial and location. CTs in the Aggregate Analysis dataset from ClinicalTrials.gov (AACT) were identified using MeSH terms. The distribution of mid-phase (MP)(phase I/II,II) and late-phase (LP)(PII/III,PIII) CTs for the ten most represented cancer types by number of sites was assessed using network graph theory and geographic analysis comparing distribution of trials across metropolitan statistical areas. Results: 66,566 CT sites were identified across the sample, 59.6% were in the United States (MP: 50.2%; LP: 42.9%). Geographical availability of CTs and local cancer incidence rates were highly correlated (0.797, p≤ 0.001) but varied depending upon disease type. Network density (the degree of dyadic interconnections between sites studying similar cancer types) showed overall that MP trials were less dense with sparser interconnections among sites than LP trials. Network density of LP trials was higher for cancer types that had poorer correlation between geographic distribution of incidence and enrolling sites (-0.777, p=0.008). MP trials did not show a similar trend. Conclusions: The relationship between the distribution of CT and site location can be envisaged through geographic and network analysis of CT registry data. LP high-density networks should strive to diversify trial locations to better meet regional incidence rates. [Table: see text]
How do social factors explain outcomes in non-small cell lung cancer among Hispanics/Latinos in California?
Authors: Patel Manali I. , Chang Ellen T. , Gomez Scarlett Lin , Schupp Clayton , Wakelee Heather A. 
Published: March 2020

6050 Background: Hispanics in the United States have a lower age-adjusted incidence and mortality rate from non-small cell lung cancer compared with non-Hispanic whites. Previous studies have demonstrated the influence of nativity on survival among Hispanic patients but no studies have evaluated the interplay of nativity, clinical factors, social factors, and neighborhood factors on survival among Hispanic patients with non-small cell lung cancer. Methods: All Hispanic patients with non-small cell lung cancer between the years of 1988-2008 were identified in the California Cancer Registry (CCR). Kaplan Meier curves depict survival by nativity status among Hispanics with non-small cell lung cancer. Cox proportional hazard models estimate the hazard of mortality by race with adjustment for individual covariates (age, gender, marital status), clinical factors (histologic grade, surgery, radiation, and chemotherapy), and social and neighborhood factors (neighborhood and ethnic enclave status). Results: A total of 4,062 Hispanic patients with non small cell lung cancer were included. Overall, there was a 7% decreased risk of disease-specific mortality for foreign-born patients as compared with US-born patients (HR 0.93, p=0.08, 95% CI 0.87-1.00) although not-statistically significant. Adjustment for individual patient factors and clinical factors conferred a statistically significant 16% decreased risk of disease-specific mortality compared with US-born patients (HR 0.84, p<0.0001, 95% CI 0.78-0.91). Adjustment for socioeconomic status and neighborhood socioeconomic and ethnic enclave status did not explain the differences in survival (HR 0.84, p <0.001, 95% CI 0.78-0.91). Conclusions: Overall, foreign-born Hispanics with non-small cell lung cancer have a decreased risk of disease-specific mortality compared with US-born Hispanics with non-small cell lung cancer but social factors do not explain this survival advantage. Further investigation is needed to understand the drivers of the survival advantage outcomes in foreign-born populations.
Examining patient choices for metastatic breast cancer drugs.
Authors: Smith Mary Lou , White Carol B , Railey Elda , Storniolo Anna Maria , Sledge George W. 
Published: March 2020

6053 Background: Patients with metastatic breast cancer face difficult drug decisions. Our previous research (ASCO Proc 2011, abstr 6044) focused on general benefit and toxicity showed that conjoint analysis (CA) allows patients to express preferences; our current research quantifies patient preference for specific drug profiles (capecitabine and paclitaxel). Methods: Research Advocacy Network and CBWhite conducted research using CA for DOD Center of Excellence for Individualization of Therapy in Breast Cancer. An online survey was sent by four breast cancer organizations (N=641). Questions elicited views on trade-offs between benefit and type/severity/duration of toxicity. CA questions present pairs of hypothetical treatments and ask respondents their preferred alternative; a follow-up question asks whether the person would take the treatment if it were the only option available. Analysis of response patterns allows study of treatment preferences for combinations of benefit and described toxicity. Results: See table. Preferences show much greater attention to benefit than to toxicity. When CA is used to examine impact of biomarkers, focus on benefit continues. Paclitaxel profile (IV) set with moderate PN lasting 1 year post treatment: with 33% benefit LH, 6% of respondents change treatment decision if biomarker predicts 27% vs 60% toxicity likelihood; with 27% toxicity LH, 22% of respondents change treatment decision if biomarker predicts 20% vs 50% benefit likelihood. Conclusions: For patients with metastatic disease, CA shows much greater attention to benefit than toxicity, and high likelihood to take treatment with at least 30% chance of benefit for any toxicity tested here. These results suggest biomarkers (for the profiled drugs) predicting benefit are more likely to be used to affect patient treatment decisions than biomarkers for toxicity. [Table: see text]
Health care costs associated with venous thromboembolism in select high-risk ambulatory solid tumor patients in the United States.
Authors: Khorana Alok A. , Dalal Mehul , Lin Jay , Connolly Gregory Clayton 
Published: March 2020

6059 Background: Venous thromboembolism (VTE) is an increasingly common complication of cancer and its treatment, including chemotherapy. VTE has significant clinical consequences, including mortality. However, contemporary data on the healthcare costs of cancer-associated VTE are limited. We examined the real-world economic burden of VTE in ambulatory patients initiating chemotherapy for select common high-risk solid tumors. Methods: Healthcare claims data (2004-2009) from the IMS/PharMetrics Patient-Centric database were collected for propensity score-matched adult cancer (lung, colorectal, pancreas, stomach, bladder and ovary) patients with VTE (n=912) and without VTE (n=2,736) after initiating chemotherapy. Healthcare resource utilization (inpatient, outpatient medical, and outpatient prescription drug claims) and costs were compared between the two cohorts during 12 months’ follow-up after the index VTE event. Incremental costs of VTE were adjusted for demographic and clinical covariates. Results: Cancer patients with VTE had ~3-times as many all-cause hospitalizations (mean 1.38 vs. 0.55 per patient) and days in hospital (10.2 vs. 3.4 per patient), and more outpatient claims (331 vs. 206 per patient) than matched cancer patients without VTE (all P<0.0001). Cancer patients with VTE incurred significantly higher overall (all-cause) inpatient costs (mean $21,299 vs. $7,459 per patient), outpatient costs (mean $53,660 vs. $34,232 per patient) and total healthcare costs (mean $74,959 vs. $41,691 per patient) than cancer patients without VTE (all P<0.0001). Total VTE-related healthcare costs were (mean) $9,247 per VTE patient over 12 months. Adjusted incremental all-cause healthcare costs of VTE were (mean) $30,538 per patient across the selected tumors, ranging from $11,946 per patient for gastric cancer to $38,983 per patient for pancreatic cancer. Conclusions: VTE results in significant inpatient and outpatient resource utilization, and increased all-cause (in addition to VTE-related) healthcare costs. Measures to prevent outpatient cancer-associated VTE may reduce healthcare utilization and costs in high-risk cancer patients.
Use and spending on antineoplastic therapy (AT) in the Medicare population and the role of supplemental coverage.
Authors: Davidoff Amy J. , Shaffer Thomas , Zuckerman Ilene H. , Pandya Naimish B. , Stuart Bruce C. , Erten Mujde Z. , Shoemaker J. Samantha , Bryant-Comstock Lynda , Shenolikar Rahul 
Published: March 2020

6060 Background: Oral antineoplastic agents (OAA) represent a growing sector of cancer therapy. Prior studies of older adult cancer patients (pts) examined use of infused/ injected chemotherapy (IICT) covered by Medicare Part B. We examined trends in IICT and OAA use, and the effect of supplemental coverage on AT use and spending. Methods: We used Medicare Current Beneficiary Survey data (1997-2007). Newly diagnosed cancer pts were selected using ICD-9CM codes. IICT use was identified from Part B claims; OAAs were identified from self reported prescription medication events. Supplemental coverage and pt characteristics were assessed from administrative records and self-report. Total spending summed payments from all sources during the cancer diagnosis and subsequent year. Logistic regression examined factors associated with use of any and type of AT; Generalized Linear Models estimated factors associated with spending. Results: Of 1,836 newly diagnosed cancer pts 559 (31%) received AT; 395 (21%) used IICT and 253 (15%) used OAAs. Spending per user was $7,544(AT), $9,892 (IICT), and $1,535 (OAA). Supplemental coverage was associated with increased odds of AT use compared to no supplemental coverage (see Table). Cancer site and age were key predictors of spending among users. OAA spending increased during 2006-7 relative to 2004-5. Conclusions: AT use in Medicare beneficiaries is sensitive to the presence but not type of supplemental coverage. OAAs were used by a relatively large proportion of cancer pts receiving AT, although spending was less than for IICT during this largely pre-Part D period. With the growing number of relatively new OAAs, and more in the pipeline, monitoring the role of supplemental coverage, and particularly the role of Part D on access and spending is a critical area for ongoing research. [Table: see text]
Patient-related predictors of poor-quality pain care in advanced lung cancer patients.
Authors: Lennes Inga Tolin , Temel Jennifer S. , Gallagher Emily R. , Greer Joseph A. , Pirl William F. 
Published: March 2020

6062 Background: Unrelieved pain remains a major problem for all patients, including those with cancer, despite national standards for pain management. Screening and addressing pain is an integral part of oncology visits and an ASCO QOPI indicator of quality oncology care. The goal of this study was to assess associations between patient-related factors, particularly patient distress, and meeting ASCO quality metrics for appropriate management of pain in patients with advanced lung cancers. Identification of patient related factors could lead to targeted quality improvement efforts. Methods: From 8/07 to 9/10, we recruited consecutive new patients in a multidisciplinary thoracic oncology clinic to participate in a research database for which patients completed self-report instruments for distress, depression (PHQ-9) and anxiety (GAD-7), at their first oncology visit. We then performed a QOPI chart audit for patients with advanced lung cancer who received care at our institution. A composite measure of appropriate pain management was calculated. Components of the composite measure included 1) documentation of pain assessment, and 2) for patients with moderate-severe pain (≥4 on 10 point scale) plan of care documentation. Results: 253 patients completed baseline assessments and had follow up. Pain was assessed in 252 (99%) patients. Over a third (88/253) of newly diagnosed advanced lung cancer patients had at least moderate pain on their first visit to the medical oncologist. Almost half of patients with moderate-severe pain were depressed (40/88). Of the patients with moderate-severe pain, 54/88 (63%) had a plan of care related to pain documented in the oncologist’s note. In total, 219 (87%) patients received appropriate pain assessment and care. In a multivariate model including age, sex, histology, ECOG PS, provider, depression, and anxiety, only depression independently predicted inadequate pain care. Depressed patients were 3 times more likely to receive poor quality pain care (OR 2.75, 95% CI 1.04-7.25, p=0.04). Conclusions: At initial oncology visit, pain is present in over a third of patients with advanced lung cancer. Depression is highly co-morbid with pain and appears to be a risk factor for inadequate pain care.
Impact of county-level surgical specialist density on breast (BrCa) and lung cancer (LuCa) mortality.
Authors: Karpov Andrei , Cheung Winson Y. 
Published: March 2020

6064 Background: Variations in distribution of the surgical workforce may result in differential access to cancer screening and treatment. Our aim was to explore the relationship between county-level surgical specialist density and BrCa and LuCa mortality. Methods: Using data from Area Resource File, US Census and National Cancer Institute, regression models that controlled for cancer incidence, county demographics and socioeconomic factors were constructed to examine the association among a) general surgeon (GS) and radiation oncologist (RO) density with BrCa mortality and b) thoracic surgeon (ThS) and RO density with LuCa mortality. Plastic (PS) and transplant surgeons (TrS) were used as surgical controls as they were not expected to correlate significantly with BrCa or LuCa mortality. Results: A total of 1,557 and 2,044 US counties were analyzed for BrCa and LuCa, respectively: mean incidences were 119 and 75 and death rates were 25 and 59 per 100,000 people, respectively, for BrCa and LuCa. Mean specialist densities were 7.72 (GS), 0.80 (RO), and 0.97 (PS) [for BrCa counties] and 0.55 (ThS), 0.55 (RO), and 0.01 (TrS) [for LuCa counties] per 100,000. When compared to counties with no surgical specialist, those with at least one GS and RO for BrCa and at least one ThS and RO for LuCa were associated with decreased mortality (Table). Increasing the density of GS and RO beyond 9 and 1 per 100,000 did not result in significant reductions in BrCa mortality. Likewise, increasing the density of ThS and RO to above 1 each per 100,000 failed to yield further improvements in LuCa mortality. Counties with more elderly residents also correlated with worse BrCa and LuCa outcomes. Conclusions: The presence of specific surgical specialists is associated with lower BrCa and LuCa mortality. There appears to be a threshold at which point further increase in their density do not contribute to continued improvements in outcomes. Distributing the surgical workforce across all counties will offer population-based improvements in BrCa and LuCa mortality. [Table: see text]