bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterizing patients with breast cancer who seek second opinions at an academic cancer center.
Authors: Fracci Sarah , Balanean Alexandrina , Kapadia Heli , Swamy Sidarth , Grace-Louthen Cathy , Lo Shelly S. , Silva Abigail , Markossian Talar 
Published: May 2020

e19229 Background: Although second-opinion (SO) seeking is common in the field of oncology, there is limited empirical research on its drivers and consequences. This study’s objective is to compare the demographic and tumor characteristics between patients with newly diagnosed breast cancer who seek out SOs for treatment planning purposes with those who do not. Methods: This retrospective study includes women with newly diagnosed breast cancer who attended a single academic cancer center between 2017 and 2018 for an initial treatment consultation. Data elements were extracted from the medical record. Characteristics of first opinion and SO seekers were compared using descriptive statistics and chi-square testing. Multivariate logistic regression was used to identify predictors of SO seeking. Odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated. Results: Of the 547 newly diagnosed patients, 147 (26.8%) were SO seekers. Compared to those seeking a first opinion, SO seekers were statistically significantly more likely to be younger and White and to have multiple primary (versus single) tumors, and have more advanced stage (II-IV) tumors. The two groups did not differ in terms of marital status, insurance, tumor grade, and tumor hormone receptor status. In the multivariate analysis, age, race/ethnicity, and tumor stage remained statistically significant. Compared to those age 65 and older, those age <54 (OR=2.28; 95% CI:1.38-3.79) and those age 55-64 (OR=1.83; 95% CI:1.10-3.06) had a higher odds of seeking a SO. Compared to White women, Black (OR=0.33; 95% CI:0.18-0.63) and Hispanic women (OR=0.51; 95% CI:0.25-1.05) had a lower odds of SO seeking. Women with advanced stage tumors (OR=1.86; 95% CI:1.22-2.86) had a higher odds of seeking a SO compared to those with earlier stage tumors. Additionally, SO seekers had higher odds of multiple primary tumors (OR=1.63; 95% CI:0.99-2.69). Conclusions: In this study, SOs for breast cancer care were relatively common. SO seekers were more likely to be younger, White, and to have more advanced disease stage. Further analyses will include investigating the role of psychosocial factors in SO seeking and treatment changes resulting from SOs. More research on the value of SOs is needed to help guide patients and providers.
Number of sentinel lymph nodes (SLN) removed in breast cancer (BC) patients undergoing sentinel lymph node biopsy (SLNB) in the province of Saskatchewan, Canada: Real-world experience.
Authors: Wees Tyrell , Narasimhan Gopinath , Souied Osama , Khan Muhammad , Bashir Ayesha , Ahmed Shahid , Ahmed Osama , Salim Muhammad , Chalchal Haji I. 
Published: May 2020

e19240 Background: SLNB is considered standard of care for BC patient's undergoing surgery. This standard of care is based on several randomized, prospective clinical trials showing non inferiority of this procedure compared to full axillary lymph node dissection (FALND). Retrieval of less than 3 lymph nodes at the time of SLN biopsy has been shown to be associated with decrease in disease specific survival. In the NSABP B-32 study, removal of two SLN rather than one almost halved the false negative rate. SK has an area of 651,900 square kilometer, with a small population of 1,098,352. This population is widely distributed throughout the province with variable access to health care. This study provides us with a unique opportunity to see if data obtained in clinical trials can be replicated in community settings. Methods: After approval from SK Cancer Agency and research ethics board of University of SK. Female Patient’s with BC who underwent SLNB from Jan 2010 to Dec 2014, were identified using cancer registry. 529 charts were reviewed retrospectively. Exclusion criteria’s were Male BC, pathology other than invasive ductal or lobular, locally advanced or metastatic disease, T4 tumors, patients who received neo adjuvant therapy, patients who had declined or were unable to receive post-operative recommended adjuvant systemic or radiation therapy, patients with full axillary lymph node dissection. Data was analyzed using SAS 9.4 software. Results: Rate of 1, 2 and 3 or more SLN was 21, 35 and 44% respectively. The median number of lymph nodes retrieved were 2. 14% of patients had positive lymph nodes. 259/529 (48.9 %) of patients used both vital blue dye and radiotracer method for detection of SLN. In 510/529 (96.4%) radiotracer method was used to detect lymph nodes. Blue dye was used in 264/529 (49.9%). Median number of SLN retrieved using both methods were 2. No change in median number of SNL retrieved in different quadrants and central part of the breast were noted, the number remained 2. Conclusions: Our review showed that rate of single lymph node retrieval was lower than what is reported in US SEER data base study of 37%, however the number of median lymph node retrieval was 2 which is considered less than optimal with reported higher rate of false negative rate. We did not attempt to look at disease-specific survival as our sample size is small. Continued data evaluation of established practice is required to improve quality of care and replication of advances established in clinical trials.
Engaging patients on tumor boards: A multi-stakeholder perspective study.
Authors: Smith Kelly M , Hill Mary A , Rosendall Kelly , Farha Maen 
Published: May 2020

e19243 Background: Patient and family-centered care (PFCC) is grounded in the concepts of dignity and respect, information sharing, and active participation and collaboration in their health care. Efforts to engage patients and family members as part of the healthcare team as part of robust multidisciplinary breast cancer care (MBCC), including in multidisciplinary tumor boards, is an extension of PFCC for breast cancer care. Our team explored multi-stakeholder perspectives of engaging patients as partners on a virtual multidisciplinary tumor board (MTB) using an mHealth application. Methods: We conducted a prospective cohort study employing semi-structured interviews and focus group methodology to explore stakeholder (patients with Stage 0-III breast cancer, family members/caregivers, clinicians, and tumor board staff) perspectives of engaging patients in a virtual MTB. Interviews and focus groups were audiotaped, transcribed, and analyzed using concurrent content analysis to identify common themes. Recruitment continued until saturation of themes was achieved. Results: We conducted 22 interviews and 5 focus groups with 49 participants. Patients and family members reported discomfort with idea of engaging in MTB discussions about their cancer. Disease burden, limited understanding of medical terminology, and not wanting to be a part of the early discussions about their disease (e.g., being overwhelmed, need to trust clinician’s advice) were commonly reported. Clinicians and staff also reported concerns about patient engagement in MTB. Clinicians reported that it may change the candor of the discussions at MTB and obfuscate the problems/issues if they needed to modify their language to accommodate patients’ sensitivities. Clinicians and staff were also concerned about patient’s perception of discordance within the MTB clinician members and how to explain this uncertainty to patients. Staff concerns centered around the use of medical terminology which may create anxiety and result in patient misunderstanding. Conclusions: Clinicians, staff, patients and family members were overwhelmingly concerned about adding patients to the MTB. Engaging patients in the frank and candid early treatment planning discussions may need further evaluation in a clinical environment and among different patient cohorts.
Impact of a multidisciplinary tumor board in the treatment of genitourinary tumors: Real-world data from a referral center in Mexico.
Authors: Salazar-Mejía Carlos Eduardo , Zayas-Villanueva Omar , Wimer-Castillo Blanca Otilia , Gallegos-Arguijo Daniel Alberto , Piñeiro-Retif Rafael , Arrambide-Gutiérrez Gustavo , Gutiérrez-González Adrián , Salinas-Chapa Matías , Hernández-Barajas David , Vidal-Gutiérrez Oscar , González-Guerrero Juan Francisco , Vera Badillo Francisco Emilio 
Published: May 2020

e19248 Background: International guidelines for genitourinary cancers recommend treatment decisions by a multidisciplinary tumor board (MTB). The benefits of a MTB include greater accuracy in staging and in the probability of receiving care in compliance with international clinical practice guidelines, greater access to clinical trials, better communication between treating physicians and cost-effective care with greater patient satisfaction, which could translate into better outcomes. Our objective was to assess the impact of a MTB in the management of patients with genitourinary tumors in a tertiary referral university center of México. Methods: We performed a retrospective analysis of all cases presented to the Genitourinary Tumor Committee of our hospital from March to August 2019. Results: A total of 84 patients were included in the analysis; of these 80% were men with a median age of 61 years. Of all the cases, 68% were first-time presentations with a median time from evaluation to presentation of 4 days. The most frequently discussed diagnoses were prostate, urothelial and renal cancer, each corresponding to about 28% of the sample. Forty-six percent of the cases presented were in metastatic disease. The median time for discussion of each case after its presentation was 10 minutes. Changes were made in the clinical stage and treatment plan proposed by the most responsible physician in 4% and 46% of the cases, respectively, achieving a unanimous consensus in 88%. After the MTB session, 29 patients were lost to medical follow-up and were not subsequently evaluated. Among the 55 patients who underwent reassessment, the recommendations of the MTB were applied in 92%. Conclusions: Discussion of urologic oncology cases at the MTB led to a change in the treatment plan in almost half of the patients. Although MTBs are an increasingly common practice in Mexico, this is the first study that describes the impact that these sessions have on the management of genitourinary tumors in our population. The high rate of loss to medical follow-up remains an important problem in developing countries, negatively affecting the prognosis of these patients.
Immune related adverse effects (IRAEs) in patients with cancer who received immune checkpoint inhibitors (ICIs): A single center experience from rural Maine.
Authors: Patwari Anannya , Bhatlapenumarthi Vineel , Harb Antoine Joseph , Curtis Adam 
Published: May 2020

e19265 Background: ICIs are used for a variety of malignancies and have shown to improve survival, but they are associated with IRAEs. We aim to identify the frequency and severity of new IRAEs and flares of preexisting autoimmune (AI) disorders excluding thyroid disorders in cancer patients treated with ICIs at our institution. Methods: We conducted a retrospective chart review analysis of all cancer patients who received ICIs: nivolumab, pembrolizumab, atezolizumab and durvalumab at the Northern Light Cancer Institute from June 2015 to March 2019. We excluded patients who received ipilimumab. We then studied those who developed IRAEs. Results: Out of 465 who received ICIs, 115(24.7%) developed IRAEs. 83 out of 298 (27.9%) nivolumab recipients, 20/121 (15.7%) pembrolizumab recipients, 5/26 (19.2%) atezolizumab and 7/20 (35%) durvalumab recipients developed IRAEs. Some patients had multiple toxicities. Median age at cancer diagnosis was 66 years, evenly split among males and females. Majority (63%) were treated for Lung cancer, followed by melanoma (20%) and genitourinary cancers (12%). Summary of new IRAEs are as noted in the table below. In patients with new IRAEs treatment was held in 29(6%) for a median duration of 7.2 wks. Upon rechallenge with the same ICI in 27 patients, 20(74%) tolerated and 7 did not leading to permanent discontinuation. Majority were treated with steroids and some required immunomodulators. Interestingly 39(8%) patients with underlying AI condition received ICIs. Of these 11(28.2%) developed flares, resulting in permanent discontinuation of drug in 4. The majority tolerated the treatment well. Treatment was permanently discontinued in 70(15%), 26(6%) required hospital admission for IRAEs. Pneumonitis was the most common toxicity necessitating treatment discontinuation and hospital stay. Conclusions: In real world setting the frequency and severity of IRAEs was more than the reported literature data, leading to higher rates of permanent discontinuation of treatment. [Table: see text]
Trends in lung cancer mortality between 2001 and 2017: An observational study in USA and EU.
Authors: Jani Chinmay , Marshall Dominic C , Singh Harpreet , Shalhoub Joseph , Salciccioli Justin 
Published: May 2020

e19277 Background: The lung is the commonest site of cancer and has the highest worldwide cancer-related mortality. Past two decades has seen advancements in screening technologies and guidelines, as well as new modalities for treatment. Few studies have reported on lung cancer trends in the 21st century. Our study reports and compares trends in lung cancer mortality in the USA and European Union (EU). Methods: We utilized the World Health Organization (WHO) Mortality Database and Center for Disease Control (CDC) Wonder database. We extracted Lung Cancer mortality data from 2001 to 2017 based on ICD 10 system. Crude mortality rates were dichotomized by sex and reported by year. We computed Age Standardized Death Rates (ASDRs) per 100,000 population using the World Standard Population and USA Standard Population. Lung cancer mortality trends were compared using Joinpoint regression analysis. Results: We analyzed a data from a total of 26 EU countries and USA, of which 6 countries had data till 2017, 12 till 2016, 7 till 2015 and 2 till 2014. We observed that mortality in men was down-trending in all countries except Cyprus and Portugal. In females, there was an increase in mortality in 22 countries. Amongst EU nations, most recently (2017) Hungary had the highest ASDRs for both males and females (64.5/100,000 and 31.0/100,000), whereas the lowest mortality was in Sweden for males (17.3/100,000) and Lithuania for the females (7.58/100,000). Latvia had the highest Estimated Annual Percentage Change (EAPC) in male mortality (-9.6%). Based on recent most data, we saw that there was a significantly lower mortality in males amongst European nations that joined the EU pre-2004 as compared to those that joined the EU post-2004 (p = 0.006). In USA, ASDRs in males and females were 44.3/100,000 and 30.6/100,000, respectively, with EAPC of -5.1% and -4.2% in males and females, respectively. Conclusions: For the study period, we observed expected decrease in lung cancer mortality in males. In contrast, there was a gradual rising trend in lung cancer mortality amongst females. In addition, there was substantial variation between nations. USA has shown consistent downtrend since 2001 where as there have been fluctuations in trends in other EU nations.
Establishing the common oncology data model for the national biobank consortium of Taiwan.
Authors: Yi-Hsin Yang , Chen Li-Tzong , Huang Shiu-Feng 
Published: May 2020

e19283 Background: Taiwan has 32 biobanks under Government’ governance. The Ministry of Health and Welfare have established a National Biobank Consortium of Taiwan to unify the specimen quality and the medical record database. The total recruited participants exceed 350,000. The National Health Research Institutes in Taiwan hold the responsibility of establish a common data model for aggregating data elements from electronic health records (EHRs) of institutes through direct feeds. The goals are to assemble a set of common oncology data elements and to facilitate cancer data interoperability for patient care and research across institutes of Biobank Consortium. Methods: We first conduct a thorough review of available EHR data elements for patient characteristics, diagnosis/staging, treatments, laboratory results, vital signs and outcomes. The data dictionary was organized based on HL7 FHIR and also included data elements from Taiwan Cancer Registry (TCR) and National Health Insurance (NHI) Program, which the common definition has already been established and implemented for years. Data elements suggested by ASCO CancerLinQ and minimal Common Oncology Data Elements (mCODE) are also referenced during planning. The final common model was then reviewed by a panel of experts consisting oncologists as well as data science specialists. Results: There are finally 9 data tables with 281 data elements, in which 248 of them are from the routinely uploaded data elements to government agencies (TCR & NHI) and 33 elements are collected with partial common definition among institutes. There are 164 data elements which are to be collected one observation per case, while 117 elements will be accumulated periodically. Conclusions: A comprehensive understanding of genetics, phenotypes, disease variation as well as treatment responses is crucial to fulfill the needs of real-world studies, which potentially would lead to personalized treatment and drug development. At the first stage of this project, we aim to accumulate available EHR structured data elements and to maintain sufficient cancer data quality. Consequently, the database can provide real-world evidence to promote evidence-based & data-driven cancer care.
Real-world (RW) systemic treatment patterns and clinical outcomes in locally advanced (LA) and recurrent or metastatic (R/M) cutaneous squamous cell carcinoma (cSCC) patients (pts).
Authors: Vo Thao , Boyd Marley , Espirito Janet L. , Gumuscu Burak , Chirovsky Diana Romana , Robert Nicholas J. , Swaby Ramona F. , Zhou Wei , Cowey Charles Lance 
Published: May 2020

e19284 Background: Data is limited on RW systemic treatments, objective response rate (ORR), response duration (DOR), overall survival (OS), and time-to-treatment discontinuation (TTD) for cSCC. Clinical trials (CTs) use RECIST criteria for response assessment; however, frequency of follow-up imaging and availability/precision of tumor lesion measures outside of trials can vary across pts. Understanding the types of image-informed responses and outcomes available in clinical practice may inform RW study design and interpretation. Methods: Adults with LA and R/M cSCC receiving first-line (1L) systemic treatment from 09/04/2014 to 06/30/2017 in US Oncology community practices, with follow-up to 06/30/2018, were included. Baseline radiologic scan was required; pts in CTs or who had concurrent cancers or immunosuppressive disorders/treatments were excluded. The primary endpoint was RW ORR using RECIST 1.1, based on tumor lesion sizes (if available) in imaging reports from the iKnowMed electronic health record. If RECIST could not be applied, physician-assessed responses were used. Pts not evaluable for response were classified as non-responders. DOR, OS, and TTD were assessed using Kaplan-Meier methods. Results: 51 (11 LA + 40 R/M) cSCC pts were eligible. Median age was 76 yrs, 80% male, 86% Caucasian, 65% ECOG PS of 0/1. The primary location was head/neck in 67%. The most common 1L regimens were cetuximab (51%), carboplatin + paclitaxel (22%), and cisplatin (6%). Conclusions: Cetuximab was the most common treatment. OS and TTD in advanced cSCC were short. RW ORR was lower using RECIST than with physician assessment; however, few pts were evaluable by RECIST due to differences in available data in prospective vs. retrospective settings. [Table: see text]
Real-world burden of chemotherapy-induced myelosuppression: Results of a U.S. online survey of patients with cancer.
Authors: Epstein Robert S. , Aapro Matti S. , Basu Roy Upal K. , Salimi Tehseen , Krenitsky JoAnn , Leone-Perkins Megan L. , Crawford Jeffrey 
Published: May 2020

e19299 Background: Research into the real-world impact of chemotherapy (CT)-induced myelosuppression on patients’ lives is limited. This study aimed to investigate the impact of CT-induced myelosuppression on patients with lung, breast, or colorectal cancer (CRC). Methods: Following Institutional Review Board approval to proceed with exception, a survey of participants identified from an online U.S. patient panel was conducted in Nov/Dec 2019. Participants who had been treated with CT in the past year and experienced ≥1 episode of myelosuppression (‘a decrease in bone marrow activity resulting in the reduced production of blood cells’) were eligible for participation. The survey was administered with predominantly close-ended questions, and lay definitions of key terms were provided to aid response selection. Descriptive statistics were used to summarize key findings. P values were calculated using the Chi-square test. Results: 301 participants completed the online survey (breast cancer, n = 153 [51%]; lung cancer, n = 100 [33%]; CRC, n = 48 [16%]). Most participants were aged > 40 years, 60% were female, 60% were currently employed, and 75% had been diagnosed with cancer within the last 3 years. Anemia, neutropenia, lymphopenia, and thrombocytopenia were reported by 61%, 59%, 37%, and 34% of participants, respectively. Fatigue was the most commonly noted side-effect of CT (reported by 72% of participants), with 55% of participants rating it as highly bothersome (9 or 10 on a 1–10 scale of ‘bothersomeness’). Most participants (89%) considered myelosuppression to have a moderate or major impact on life (major life impact, 40%; moderate life impact, 49%; minor life impact, 12%). Patient-reported impact of myelosuppression was significantly higher among participants aged < 50 years vs those aged ≥50 years (p = 0.01); however, no significant differences were observed when participants were stratified by sex, employment status, comorbidities (depression, diabetes, hypertension), or type of cancer. Significantly more participants with fatigue, considering themselves to have a weakened immune system, or noticing easy bruising/bleeding reported a major life impact vs those without these side effects (44% vs 27%, 52% vs 26%, and 50% vs 34%, respectively; all p < 0.01). Conclusions: These data provide further insights into the substantial real-world patient burden of symptoms arising from CT and associated with myelosuppression. Preventing or proactively managing CT-induced myelosuppression could have a major impact on patients’ quality of life.