bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cumulative incidence of financial hardship in metastatic colorectal cancer patients: Primary endpoint results for SWOG S1417CD.
Authors: Shankaran Veena , Unger Joseph M. , Darke Amy , Suga Jennifer Marie , Wade James Lloyd , Kourlas Peter , Chandana Sreenivasa R , O'Rourke Mark Allen , Satti Suma , Liggett Diane , Hershman Dawn L. , Ramsey Scott David 
Published: May 2020

7010 Background: Despite evidence that rising cancer care costs are contributing to “financial toxicity” in cancer pts, no studies, to our knowledge, have prospectively assessed the financial impact of cancer diagnosis (dx) using both self-reported and objective financial measures. S1417CD, led by the SWOG Cancer Research Network and conducted in the NCI Community Oncology Research Program (NCORP), was the first national prospective cohort study to evaluate time-to-first evidence of major financial hardship (MFH) in pts with newly diagnosed mCRC. We present results of the primary endpoint analysis. Methods: Pts age ≥ 18 within 120 days of mCRC dx receiving systemic treatment completed surveys every 3 months (mo) for 12 mo. MFH was defined as ≥ 1 occurrence of self-reported increase in debt, new loans, selling home, refinancing home, or ≥ 20% income decline during the 12 mo study period. Cumulative incidence (CI) of MFH was estimated to account for competing risk of death. Additional endpoints, not reported here, included quality of life, caregiver strain, and changes in credit status over 12 mo. Results: In total, 380 pts (median age 59.9) across 126 clinic sites were enrolled, with 377 eligible and evaluable for the primary endpoint (reached 12 mo assessment, death, or MFH endpoint); complete data were available for 92% of pts as of Jan 23, 2020. Most pts were white (78%), male (61%), and insured (98%), with annual income ≤ $50,000 (56%). Cumulative incidence of MFH at 12 mo was 71.5% (95% CI: 65.9%-76.3%), with 24.6%, 52.4%, and 61.8% at 3, 6, and 9 mo. The dominant components of MFH were new debt (12-mo CI, 56.7%) and >20% decline in income (26.7%); 104 (41%) pts reported ≥ 2 elements of MFH. In a secondary analysis excluding new debt, 12 mo cumulative incidence of MFH was 42.9% (95% CI: 37.2%-48.5%), with 10.3%, 24.4%, and 31.9% at 3, 6, and 9 mo. Conclusions: In a national sample of mCRC pts on systemic tx, financial hardship, most commonly in the form of increased debt, accumulates progressively over time. Nearly 3 out of 4 pts experiencing MFH at 12 mo despite access to health insurance coverage. These findings underscore the need for clinic and policy solutions such as early financial navigation and elimination of cost sharing to protect pts from financial devastation as they continue with tx. Clinical trial information: NCI-2015-01885 . [Table: see text]
Geographic and demographic disparities in breast cancer outcomes: A population-based study.
Authors: Gosain Rohit , Abdou Yara , Gupta Medhavi , Sarma Maithreyi , Groman Adrienne , Gandhi Shipra 
Published: May 2020

7028 Background: Breast cancer (BC) is one of the leading causes of cancer-related mortality worldwide, with over 2 million new cases diagnosed each year. Area of residence has been shown to affect survival, but its impact on BC is unknown. The purpose of this study is to address the potential disparities in BC outcomes between the urban area (UA) and rural area (RA). Methods: We obtained data based on BC patients’ (pts) area of residence; UA vs RA, using the Surveillance, Epidemiology, and End Results (SEER) database treated from 1975-2016. Different socio-demographic variables and tumor characteristics (cts) from both groups were analyzed. Disease specific survival (DSS) and overall survival (OS) were analyzed by Kaplan-Meier methods. Multivariable analyses were conducted using Cox regression models. Results: A total of 99,339 and 872,742 pts were analyzed from RA and UA respectively. Pt cts, including age, sex, marital status, insurance status were similar across both RA and UA. There were a higher number of Black and Hispanic pts in the UA compared to RA. A total of 264,191 pts had receptor subtype data available. A slightly higher percentage of triple negative BC (TNBC) pts was seen in the RA compared to UA (13.5% v 12.7%) whereas UA had a higher percentage of HER2+ BC (18% v 17.3%). There were 95.4% early/locally advanced (stage I-III) and 4.6% metastatic pts. UA pts had significantly improved DSS and OS regardless of stage, grade or other tumor cts compared to RA pts. When stratified by receptor subtype, UA had significantly improved DSS and OS in hormone positive (HR+) (OS HR of 0.86; DSS HR of 0.87; p < 0.05) and HER2+ pts (OS HR of 0.87; DSS HR of 0.83; p < 0.05). However, there were no significant differences seen between UA and RA pts with TNBC. Conclusions: To our knowledge, this is the first study to report BC outcomes based on geographic disparities. Interestingly, HR+ and HER2+ UA pts had better outcomes than RA pts, whereas TNBC pts had similar survival regardless of residence area. Perhaps this disparity is partly due to the longer duration of treatment needed with hormonal therapy in the adjuvant setting making compliance an important factor to take into account in RA pts, in addition to complicated decision making with upcoming data in HER2 + cancer in the early stage setting. Access to healthcare, differences in surgical and systemic approaches of pt care, management of treatment-related toxicities and environmental factors are all potential factors that may affect outcomes in BC pts. Based on the above data, further studies are needed to further evaluate and reduce such disparities.
The impact of census-tract socioeconomic status on survival in stage III colon cancer.
Authors: Dhahri Amina , Kaplan Jori Lee , Ntiri Shana , Imanirad Iman , Felder Seth , Dineen Sean Patrick , Sanchez Julian , Dessureault Sophie , Carballido Estrella M. , Powers Benjamin 
Published: May 2020

7032 Background: Socioeconomic status (SES) has been associated with worse outcomes in stage III colon cancer. However, these studies have used large geographic areas (zip codes or counties) as a proxy for SES which may bias results. To overcome this challenge, we used a national database with census-tract level SES to assess the impact on cancer-specific (CSS) and overall survival (OS). Methods: Using the SEER Census-Tract Dataset from 2004-2015, we identified 8th edition AJCC stage III colon adenocarcinoma patients who underwent curative-intent surgery and initiated adjuvant chemotherapy. The predictor variable was census-tract level SES, consisting of 7 variables such as income, housing, and education. SES was analyzed as quartiles. Statistical analysis included chi square tests for association and Kaplan-Meier and Cox regression for survival analysis. Results: We identified 27,222 patients who met inclusion criteria. Lower SES was associated with younger age, Black or Hispanic race/ethnicity, Medicaid or uninsured status, higher T stage, <12 lymph nodes examined and lower grade tumors. Median CSS was not reached; the 25th percentile CSS time was 54 months for the lowest SES (LSES) quartile and 80 months for the highest (HSES). Median OS was 113 months for LSES and not reached for HSES. The 5-year CSS rate was 72.4% for the LSES quartile compared to 78.9% in the HSES (p<0.001). The 5-year OS rate was 66.5% for LSES and 74.6% in the HSES (p<0.001). After adjusting for potential confounders (age, sex, race, insurance, pathologic T and N stage and grade), LSES was associated with increased cancer-specific death relative to the HSES (HR 1.22; 95% CI [1.114-1.327]) Conclusions: This is the first study to evaluate CSS and OS in a national cohort of stage III colon cancer patients using a granular, standardized measure of SES. Despite receipt of guideline-based treatment, low SES remained a predictor of increased cancer-specific mortality. These data suggest that investigating treatment barriers beyond adjuvant therapy is needed to address colon cancer survival disparities. [Table: see text]
A randomized controlled trial of a self-administered, online decision-aid (“Navya Patient Preference Tool”) to reduce decisional conflict in women with early breast cancer.
Authors: Joshi Shalaka P , Ramarajan Lakshmi , Deshpande Ojas , Fernandes Elizabeth , Vanmali Vaibhav , Hawaldar Rohini W , Kannan Sadhana , Parmar Vani , Nair Nita S. , Gupta Sudeep , Badwe Rajendra A. 
Published: May 2020

7033 Background: Shared decision making to confront choices with clinical equipoise, has been the privilege of those patients with access to time intensive consults with oncologists. We conducted a randomized controlled trial for breast cancer patients to use an online, self-administered, out-of-the-medical-encounter decision aid (DA) to choose between breast conserving surgery (BCS) and mastectomy. Methods: Navya Patient Preference Tool (Navya PPT) is a multilingual DA based on adaptive conjoint analysis of tradeoffs between cost, adverse effects of radiation, and breast conservation. Prior analysis established high internal reliability and external validity of the Navya PPT. Eligible cT1/2, cN0 breast cancer patients planned for surgery were block randomized, in 1:1:1 ratio, to receive the research questionnaire (RQ) to measure decisional conflict on choice of surgery (control, arm 1), Navya PPT followed by RQ (experimental, arm 2) or Navya PPT followed by RQ administered with key male family member (experimental, arm 3). Groups were stratified with respect to age, socio-economic status (SES) and educational level. The study was powered to detect a decrease in Decisional Conflict Index (DCI) by 0.25 (β-0.8, two sided α- 0.01). Results: Between June 2017 and December 2019, 247/255 patients were randomized to arm 1 (83), arm 2 (84), and arm 3 (80). Median age was 48 years (IQR 23-76), and median pT size was .5 cm (0.5-6 cm). 59% of patients were middle or lower SES and 46.2% had ≤ 12th grade education. DCI was significantly reduced in arm 2 as compared with arm 1 (1.34 vs. 1.65, Cohen’s d 0.49 (± 0.31) p<0.05) as well as in arm 3 as compared with arm 1 (1.30 vs. 1.65, Cohen’s d 0.54 (± 0.31) p<0.05). 80% (± 6%) of patients underwent surgery of choice as determined by Navya PPT. BCS rate was similar in all three arms (85.2, 88.9 and 86.5% respectively (p=0.779). Conclusions: Online, self-administered, adaptive DAs used out of the medical encounter can reduce decisional conflict and increase access to shared decision making for every patient; especially in practices with low doctor to patient ratios. Clinical trial information: IEC/0116/1619/001 .
National estimates of substance use, substance use disorders, and treatment among adolescent and young adult cancer survivors.
Authors: Ji Xu , Cummings Janet , Mertens Ann C. , Wen Hefei , Effinger Karen Elizabeth 
Published: May 2020

7042 Background: Adolescent and young adult (AYA) survivors of cancer are at an elevated risk of early-life morbidity and mortality due to the disease trajectory and treatment. Engagement in risk behaviors, including substance use, can exacerbate survivors’ vulnerabilities and place them at further risk for adverse health outcomes. This study provides national estimates of the prevalence of substance use and misuse, substance abuse or dependence (i.e., substance use disorders [SUD]), and receipt of treatment for SUD among AYA cancer survivors. Methods: We used 2015-2018 National Survey of Drug Use and Health data to identify a nationally-representative AYA sample (aged 12-34 years). Outcomes included past-year alcohol use, marijuana use, other illicit drug use, misuse of any prescription psychotherapeutic drugs (including opioid analgesics, stimulants, sedatives, or tranquilizers), and misuse of prescription opioid analgesics. Outcomes also assessed past-year SUD in aforementioned drug classes. Among those with SUD, we evaluated past-year receipt of SUD treatment. Multiple logistic regressions were estimated to compare outcomes between 846 AYAs who reported a cancer history and 142,870 AYAs who did not, adjusting for sociodemographic and need-related characteristics. Results: In bivariate analyses, AYAs with a cancer history were more likely than noncancer peers to use alcohol (78.6% vs. 63.4%; p< 0.001) and illicit drugs other than marijuana (11.2% vs. 7.8%; p= 0.02), misuse any prescription psychotherapeutic drugs (16.9% vs. 10.6%; p< 0.001) and prescription opioid analgesics (12.0% vs. 5.9%; p< 0.001), and have an illicit drug (other than marijuana) SUD (3.7% vs. 1.3%; p< 0.01) in the past year. In regression analyses, differences in past-year misuse of any prescription psychotherapeutic drug and prescription opioid analgesics persisted ( p= 0.02, p< 0.01, respectively). Among AYAs with SUD, those with a cancer history were more likely than noncancer peers to receive SUD treatment (21.0% vs. 8.1%; p= 0.01) in the past year; this difference persisted in regression analyses ( p= 0.03). Conclusions: AYAs with a cancer history had an elevated risk for misusing prescription psychotherapeutic medications, which was driven by misuse of prescription opioids; yet, only one in five AYAs with a cancer history and SUD received treatment. Our findings underscore the need for future interventions designed to reduce substance use and misuse and improve access to SUD treatment in AYA cancer survivors.
Neoadjuvant treatment with chemotherapy or chemoradiation in stage III non-small cell lung cancer: Analysis of the National Cancer Database.
Authors: Malapati Sindhu Janarthanam , Singh Sunny R K , Kumar Rohit , Hadid Tarik H. 
Published: May 2020

7046 Background: Use of neoadjuvant chemotherapy (Neo-chemo) improves survival in locally advanced NSCLC. However, data regarding the benefit of adding radiation (Neo-CRT) is limited. Meta-analyses suggest that the use of Neo-CRT could lead to significant tumor downstaging but with increase in therapy-related mortality. Methods: Patients with resected stage III NSCLC were identified from the NCDB between 2010 and 2015. Patients were divided into two groups based on the type of neoadjuvant therapy received (Neo-chemo vs. Neo-CRT). Surgical and survival outcomes were compared. Kaplan-Meier method and log-rank test were used for survival analysis. Results: Of the 136,942 patients with stage III NSCLC, 15,804 patients had definitive surgery. Mean age was higher for those who received Neo-chemo (63.8 vs. 61.8 years, p<0.0001). Median overall survival (OS) for Neo-CRT was 49.8 months and for Neo-chemo was 53.6 months. After adjusting for treatment facility, age, gender, race, comorbidity index, insurance status, T and N stage, there was a 12% reduction in mortality with use of Neo-chemo compared to Neo-CRT (p=0.03, 95% confidence interval 0.78-0.98). 3 years OS for Neo-CRT and Neo-chemo was 51.1 and 54.3%, respectively. The 30-day operative mortality rate was slightly higher in the Neo-chemo group (4.6 vs. 3.2%, p=0.004) but 90-day mortality rates were similar (7.41% vs. 6.83%, p=0.37). Length of hospital stay for primary tumor resection was shorter for the Neo-chemo group (5 vs. 6 days, p<0.0001); however, there was no significant difference in 30-day readmission rates between the two groups (91.53% vs. 94.01%, p=0.09). Conclusions: In this study, neoadjuvant chemotherapy resulted in 12% lower mortality compared to neoadjuvant chemoradiation despite the notable increase in the rate of complete pathologic tumor and nodal response achieved with the addition of neoadjuvant radiation. There was no difference in R0 resection rates, postoperative mortality or readmissions between the two groups. [Table: see text]
Long-term financial outcomes and quality of life in partners of colorectal cancer survivors.
Authors: Veenstra Christine M , Abrahamse Paul , Morris Arden M. , Hawley Sarah T. 
Published: May 2020

7048 Background: Many patients with colorectal cancer face financial toxicity, but little is known about financial outcomes among their partners. Moreover, virtually nothing is known about associations between partners’ quality of life and their financial outcomes. Methods: In 2019 we surveyed patients who, in 2014-18, underwent resection of Stage III colorectal cancer and were seen at a community oncology practice, an academic cancer center, or reported to Georgia SEER (current RR 46%). Patients gave a separate survey to their partner. 254 partners (68% RR) completed surveys. Partners were asked about financial impacts of the patient’s cancer. Partners’ quality of life (QOL) was measured with the PROMIS global health scale. Multivariable regression analyses of 3 partner-reported outcomes (1. Perception that their financial status is worse off, 2. Substantial worry about finances, 3. Debt related to patients’ cancer) were generated to assess associations between each outcome and key partner and patient variables, and associations between partners’ QOL and financial outcomes. Results: Among partners, 55% were < age 65, 64% female, 86% white, and 27% had < high school education. 61% were employed at time of patient’s diagnosis; 38% of those missed 7-30 days work and 13% missed > 1 month work due to the patient’s cancer. 66% patients were employed at diagnosis. Among those, 34% were no longer working at the time of survey. In 14% dyads only the patient was working at diagnosis and among those, 50% were no longer working at the time of survey. 32% partners reported their financial status is worse off, 36% reported substantial worry about finances, and 28% reported current debt, all due to the patient’s cancer. After adjustment for partner and patient variables, partners of patients further out from diagnosis and partners of patients who were working at diagnosis were more likely to report substantial worry. Partners < age 50, with <high school education, with >1 comorbid condition, and partners of patients who were working at diagnosis were more likely to report debt (all p < 0.05). Endorsing each of the 3 financial outcomes was associated with lower QOL among partners, after adjustment for partner and patient variables (all p < 0.01). Conclusions: Nearly 1/3 of partners of survivors of colorectal cancer reported long-term adverse financial outcomes due to the patient’s cancer. Partners of patients working at the time of diagnosis were more likely to report substantial worry and debt, perhaps because many patients who were working at diagnosis are no longer working in the survivorship period.
A personalized prediction model for hospital readmission risk for cancer patients.
Authors: Shreve Jacob Tyler , Lee Sarah , Felix Christina , Benish Shirley Rachel , Hilton Cameron Beau , Radakovich Nathan , Stevenson James , Montero Alberto J. , Nazha Aziz 
Published: May 2020

7057 Background: Cancer patients (pts) are at high risk of unplanned hospital readmissions. Predicting which cancer patients are at higher risk of readmission would improve post-discharge follow-up/navigation, decrease cost, and improve pt outcomes. Methods: We conducted a retrospective cohort study of non-surgical cancer pts hospitalized at our center between 12/2014 to 7/2018. A machine learning algorithm was trained on 348 medical, sociodemographic and cancer-specific variables with a total of 1,801,944 data points. The cohort was randomly divided into training (80%) and validation (20%) subsets. Prediction performance was measured by area under the receiver operator characteristic curve (AUC). Results: A total of 5,178 hospitalizations were included, of which 45.1% were women, and 27.6% experienced an unplanned readmission within 30 days. The most frequently represented cancers were hematologic malignancies (30.5%), followed by GI (18.1%), lung (13.7%), and GU (10.9%). Significant variables that impacted the algorithm decision are ranked from the most to the least important, including: days from last admission; planned index chemotherapy admission; number of vascular access lines, drains, and airways in use; length of stay; cancer diagnosis; total ED visits in past 6 months; age; discharge lab values (sodium, albumin, alkaline phosphatase, bilirubin, platelets); number of prior admissions; and discharge disposition. The AUC for the validation subset was 0.80. To ease the translation of this model into the clinic, we developed a web application whereby users can supply the aforementioned variables to the model and receive a personalized prediction that highlights those variables most affecting a subject’s readmission risk status: www.Cancer-Readmission.com. Conclusions: A cancer-specific readmission risk model with high AUC for 30-days unplanned readmission has been developed. The model is embedded in a freely available web application that provides personalized, patient-specific predictions. Programs that integrate this model can identify cancer patients with a greater risk for unplanned hospital readmission, thus providing a personalized approach to prevent future unplanned readmissions.
The effect of cardiovascular disease on the association between immune-related adverse events and overall survival.
Authors: Oren Ohad , Molina Julian R. 
Published: May 2020

7059 Background: Preliminary data suggests that immune-related adverse events (irAEs) are associated with lower all-cause mortality, presumably due to improved anti-tumor responses. Investigations of large cohorts are needed to establish better understanding of that association. Methods: We reviewed the Mayo Clinic database for all patients who received an immune checkpoint inhibitor (ICI). The primary outcome was all-cause mortality. Descriptive and uni-variate analyses were generated. Results: Between March, 2010 and July, 2019, 3,326 patients received an ICI. The most common irAEs were colitis (287, 8.6%), pneumonitis (238, 7.2%) and hepatitis (227, 6.9%). A total of 933 (28.1%) patients developed at least 1 irAE and 176 (5.3%) patients experienced 2 or more irAEs. Survival analysis demonstrated an association between the number of irAEs and all-cause mortality (log-rank, P < 0.0001), a relationship which was maintained for the 3 most common cancer types (lung, melanoma, renal) and for the individual ICI agents. In patients with lung cancer, colitis (P = 0.04) but not pneumonitis (P = 0.83) was associated with improved overall survival. No association between irEA and all-cause mortality was demonstrated in patients with history of stroke (log-rank, P = 0.12), peripheral artery disease (PAD) (log-rank, P = 0.68) and obesity (log-rank, P = 0.18). In an analysis of pre-ICI body-mass index (BMI), an association between irAE and lower overall mortality was shown in patients with BMI < 30 (log-rank, P < 0.001) and not in those with higher BMIs (log-rank, P = 0.09). The presence of stroke, PAD and obesity were associated with higher all-cause mortality in a survival analysis (P < 0.001). The irAE-mortality association was not modulated by the presence hypertension (log-rank, P < 0.0001), diabetes mellitus (log-rank, P < 0.0001), or heart failure (log-rank, P = 0.006). Conclusions: The development of any irAE is associated with higher overall survival. The presence of numerous cardiovascular disease states neutralizes that association, likely a result of competing causes of mortality although interaction with immune or inflammatory pathways is possible. In addition, pneumonitis is not associated with better overall survival in patients with lung cancer presumably due to compromise of already-tenuous respiratory status.