bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterizing participants in the North Carolina Breast and Cervical Cancer Control Program (NC BCCCP): A review of 90,000 women.
Authors: Tait Sarah D , Ren Yi , Horton Cushanta C. , Oshima Sachiko M. , Thomas Samantha M. , Wright Sherry , Caesar Awanya , Plichta Jennifer Kay , Hwang Eun-Sil Shelley , Greenup Rachel Adams , Rosenberger Laura Horst , DiLalla Gayle , Menendez Carolyn S. , Tolnitch Lisa , Hyslop Terry , Nelson Debi , Fayanju Oluwadamilola Motunrayo 
Published: October 2020

101 Background: Overall breast cancer mortality in the US has declined since 1990, but racial/ethnic disparities have worsened. Since 1992, NC BCCCP has provided free/low-cost breast cancer screening to underserved women as part of a national effort by the Centers for Disease Control and Prevention (CDC) to mitigate these disparities. We sought to characterize and evaluate benchmarks for this previously unstudied, state-level cohort. Methods: We identified women ≥18y who underwent their first breast cancer screening via NC BCCCP from 2009-2018. Univariate analysis was used to compare differences in timeline of care and rates of breast pathology (i.e., cancer or atypia) by race/ethnicity and age. Logistic and negative binomial regression were used to identify factors associated with cancer diagnosis and time from enrollment to diagnosis (TTD) and treatment (TTT), respectively. Results: 88,893 women with complete records were identified (median age 50y, IQR 44-56): 45.5% were Non-Hispanic (NH) white, 30.9% NH black, 19.5% Hispanic, 1.7% American Indian (AI), and 1.1% Asian. Overall participation peaked in 2012 but steadily increased among Hispanic women over time (p < 0.001). Breast pathology was diagnosed in 2,016 (2.3%) women, with rates ranging from 1% in Hispanic women to 2.7% in NH whites. After adjustment, Hispanic women were least likely (vs NH white women: OR 0.40; 95% CI 0.34-0.47) to be diagnosed with breast cancer. Median TTD was 19d and TTT was 33d, both within the CDC’s 60d standard. In univariate analyses, women < 50 had shorter TTD (median 18d vs 21d) and TTT (median 30d vs 35d) vs women ≥50 (both p < 0.01), and there were no significant differences by race/ethnicity or between women with atypia vs cancer. In multivariate models, however, older age and NH black race were associated with longer TTD and TTT. Conclusions: NC BCCCP meets national quality benchmarks for TTD and TTT. These data also highlight broader opportunities to achieve racial/ethnic parity and improve equity for breast cancer prevention. [Table: see text]
An Optimal Care Coordination Model (OCCM) for Medicaid patients with lung cancer: Results from the beta model testing phase of a multisite initiative in the United States.
Authors: Smeltzer Matthew , Boehmer Leigh , Kramar Amanda , Asfeldt Thomas , Faris Nicholas , Amorosi Christine Fay , Ray Meredith , Nolan Vikki G. , Oyer Randall A. , Lathan Christopher S. , Osarogiagbon Raymond U. 
Published: October 2020

105 Background: Medicaid patients with lung cancer have poorer outcomes than non-Medicaid patients, partly because of suboptimal care quality. The Association of Community Cancer Centers (ACCC) launched a project to develop, test, and refine an OCCM. Methods: The OCCM comprised 13 areas, spanning care access to supportive care/survivorship. Using the OCCM, 7 cancer programs in 6 US states conducted self-assessments of care delivery systems and implemented quality improvement projects. Sites worked with ACCC to conduct data benchmarked projects. Data collection and analysis were centralized. Statistical analyses used Kruskal−Wallis and chi-squared tests. Results: There were 926 patients (257 Medicaid/dual eligible; 669 non-Medicaid) across 7 sites. Medicaid/dual eligible patients were 52% male, 69% Caucasian, 48% active smokers, and 45% clinical stage III/IV. Prospective multidisciplinary case planning (PMCP), patient care access, and tobacco cessation were commonly selected for projects. PMCP evaluation used fortnightly tumor board (FTB), virtual tumor board (VTB), and multidisciplinary team huddle (MTH). Presentation of eligible patients was higher for VTB and MTH (FTB: 23%, VTB: 100%, MTH: 100%, p < 0.0001). While FTB and MTH discussed all cases prospectively, VTB achieved 80%. Median days (d) from diagnosis to presentation were 18 (FTB), 14 (VTB), and 9 (MTH, p = 0.14). Patient care access was evaluated with timeliness metrics at 2 sites. Site 1: Medicaid patients had a median of 13 d from lesion discovery to diagnosis and 21 d from diagnosis to treatment (not different from non-Medicaid; p = 0.96 and 0.38). 94% met the goal of treatment initiation within 45 d. Site 2: Medicaid patients had a median of 16 d from discovery to diagnosis and 27 d from diagnosis to treatment (not different from non-Medicaid; p = 0.68 and 0.83). Similar benchmarks were collected and compared for other assessment areas. Sites identified enhanced collaboration and improved programming (e.g., patient navigation) as successes. Challenges at project start included inadequate staffing and lack of centralized data collection and benchmarking. Importance of lung cancer–dedicated navigation, PMCP, and Medicaid patient needs were key transferable lessons. Conclusions: The OCCM is useful for cancer programs’ self-assessment of care delivery to Medicaid patients across 13 high-impact areas. Dissemination can advance multidisciplinary coordinated care delivery, but sites may need additional resources to evaluate outcomes.
Disparities in utilization of oral anticancer agents and related costs in elderly patients with metastatic renal cell carcinoma in the United States.
Authors: Wilson Lauren E , Spees Lisa , Pritchard Jessica , Greiner Melissa A. , Scales Charles D. , Baggett Chris , Kaye Deborah , George Daniel J. , Zhang Tian , Wheeler Stephanie B. , Dinan Michaela Ann 
Published: October 2020

106 Background: Although survival among patients with metastatic renal cell carcinoma (mRCC) has improved with the introduction of targeted therapies, substantial disparities in mRCC survival persist. The purpose of this study was to identify patient characteristics associated with differential adoption of emerging oral anticancer agents (OAAs) and related costs in the management of mRCC. Methods: SEER-Medicare patients diagnosed with mRCC aged 65 years or older from 2007-2015 continuously enrolled in Medicare Part D benefits for at least 1 year after diagnosis or until death were included. Associations between patient-level characteristics and OAA receipt were analyzed using univariable and multivariable log-binomal regression; associations between patient characteristics, OAA receipt, and total, cancer-specific, and OAA-specific costs in the 12 months following diagnosis were modeled as relative cost ratios using generalized linear regression with a gamma link. Reported costs were adjusted to 2015 dollars. Results: 2,792 patients with mRCC met inclusion criteria; 32.4% received an OAA in the 12 months following diagnosis. The majority of patients receiving an OAA used either sunitinib or pazopanib. Receipt increased slightly over the study period from 2007 (31% of patients) to 2015 (37%). In multivariable-adjusted models, patients of advanced age ( > 80 years RR 0.50; 95% CI 0.42-0.60) or residing in the Southern US (RR 0.83 95% CI 0.70-0.98) were less likely to receive OAAs. Married patients were 20% more likely (RR 1.19; 95% CI 1.04-1.37) to receive OAAs. After multivariable adjustment, receipt of OAAs was associated with higher total and cancer-specific costs, as was Hispanic ethnicity. Among patients receiving an OAA, the cost of OAAs to Medicare increased approximately 7% per year (95% CI 4%-9%), while patient out-of-pocket spending for OAAs decreased approximately 10% per year (95% CI 7%-14%). Out-of-pocket OAA costs were consistently lower for Black, Hispanic, and Other patient race/ethnicity categories compared to the White Non-Hispanic category. Conclusions: Patient characteristics including age at metastatic diagnosis, marital status, geographic region, and certain comorbidities are related to the likelihood of receiving OAAs. Future research is warranted to investigate if such differences in OAA use lead to differences in survival.
Effect of rurality and neighborhood disadvantage on clinical trial interest and decision-making style in patients with cancer living in the Deep South.
Authors: Caston Nicole , Williams Courtney , Ye Star , Pywell Cameron , Ingram Stacey A. , Yu Elaine , Aswani Monica S. , Azuero Andres , Rocque Gabrielle Betty 
Published: October 2020

110 Background: Patients living in rural or disadvantaged settings are historically underrepresented in clinical trials. This study sought to understand associations between neighborhood characteristics and both interest in clinical trial participation and decision-making style preference. Methods: This cross-sectional study used patient-reported outcome data from patients with cancer treated at the University of Alabama at Birmingham from January 2017 to May 2019. Rural-Urban Commuting Area Codes (RUCA) scores were used to determine rurality of patient residence. Area Deprivation Index (ADI) values (range 0-100) were used to identify patients living in the most disadvantaged (top 15%) census block groups. The Control Preferences Scale captured decision-making preference. Likelihood of interest in clinical trial participation by rurality and neighborhood disadvantage was estimated using risk ratios (RR) and 95% confidence intervals (CI) from modified Poisson regression models. Multinomial regression was used to calculate RRs and 95% CIs estimating likelihood of preferred decision-making style by rurality and neighborhood disadvantage. Models were adjusted for age, sex, race, cancer type, cancer stage, ECOG performance status, and phase of care. Results: Of 1005 patients with cancer, mean age was 67 (SD 11), 68% were female, and 74% white. Gynecologic cancer (32%) was the most prevalent diagnosis, followed by hematologic (20%) and breast (15%) cancer. Of this sample, 16% of patients lived in a rural setting and 18% lived in a disadvantaged neighborhood. Interest in clinical trial participation was no different for patients living in rural vs. urban (RR 0.93, 95% CI 0.73-1.17) or disadvantaged vs. non-disadvantaged neighborhoods (RR 0.88, 95% CI 0.69-1.13). Patients living in rural vs. urban settings trended toward increased likelihood of preferring physician- to patient-driven decision-making (RR 1.67, 95% CI 0.95-2.94). Patients living in disadvantaged vs. non-disadvantaged neighborhoods trended toward increased likelihood of preferring physician- to patient-driven decision-making (RR 1.39, 95% CI 0.82-2.35). Conclusions: Though clinical trial participation interest was similar, patients with cancer living in rural vs. urban settings trended toward increased likelihood of preferring physician- vs. patient-driven decision-making. Opportunities exist for providers to engage historically underrepresented patients for trial participation.
Effect of hospital volume on outcome of stage IV pancreatic cancer.
Authors: Goksu Suleyman Yasin , Ozer Muhammet , Bacik Goksu Busra N , Kazmi Syed Mohammad Ali , Sanford Nina Niu , Hsieh David , Sanjeevaiah Aravind , Khosama Leticia , Aguilera Todd Anthony , Beg Muhammad Shaalan 
Published: October 2020

123 Background: The effect of hospital volume on the outcome of stage 4 pancreatic cancer is not well known. We evaluated the effect of hospital volume on time to treatment and survival in patients with stage 4 pancreatic adenocarcinoma (PDAC). Methods: We used the National Cancer Database, including 1,319 hospitals to identify the study population. Adult (≥ 18 years) patients with stage 4 PDAC were included. We excluded the patients who had other histologies, unknown follow-up, and survival of less than 30 days. We categorized the hospital volume as three groups: low- (<25th centile), medium- (25th–75th centile), and high-volume hospitals (HVH) (>75th centile). Time from diagnosis to chemotherapy initiation was classified as early (≤ 6 weeks) or late (> 6 weeks). Kaplan-Meier and Cox regression methods were used to evaluate the overall survival (OS) between HVH and low-volume hospital (LVH) groups. Results: Among 72,531 patients with stage 4 PDAC; 65% received chemotherapy. Patients treated at HVH had higher rates of chemotherapy ( 73% vs. 60%, p<.001), and late chemotherapy initiation ( 27% vs. 20%, p<.001) compared to LVH. Patients at HVH were more likely to be younger, have less comorbidity score, private insurance, treated at the academic center, and need to travel more than 50 miles (all p<.001). Patients treated at HVH had better OS than LVH (6 vs. 4 months, p<.001). In multivariable analysis, HVH was independently associated with better OS versus LVH ( HR 0.79 [0.72-0.87]). In addition, HVH was associated with better OS in patients who received chemotherapy ( HR 0.78 [0.69-0.88]), while early treatment initiation, age, black race, uninsured status was not. Conclusions: Treatment at an HVH is independently associated with improved survival among patients with stage 4 PDAC. Patients seen at HVH had a higher rate of chemotherapy administration but a longer time to treatment initiation. [Table: see text]
Early-onset colorectal cancer in younger patients: A population-based study.
Authors: Huang Hu , Wang Suwei , Scheufele Elisabeth , Dankwa-Mullan Irene , Jackson Gretchen Purcell , Arriaga Yull Edwin 
Published: October 2020

124 Background: In the US, the incidence of colorectal cancer (CRC) is increasing in patients younger than 50 years who may present with advanced stage, high grade, left-sided colon or rectal cancers with signet ring cell histopathology, aggressive clinical course, and reduced overall survival. Understanding the characteristics of this population could inform screening, early detection, and optimal treatment. In this study, we describe the attributes of adults who are 50 years and younger with a first diagnosis of CRC and ascertain molecular testing rates and time to surgery by using data from a commercially insured cohort in the U.S. Methods: This retrospective study of patients ages 50 and younger with a first diagnosis of CRC utilizes the IBM MarketScan database, and focuses on claims from January 2013 to December 2018. Included patients had continuous insurance enrollment of 12 months before and 6 months after diagnosis. We determined rates of tumor testing for microsatellite instability (MSI) or immunohistochemistry (IHC) for mismatch repair (MMR) proteins and referral to genetic services in all patients, as well as mutational analysis of KRAS, NRAS, and BRAF in metastatic CRC patients. Time to surgical resection of primary tumor (TTS) in non-metastatic colon cancer patients was measured. Results: During the 5-year period, 10,577 patients ages 18 to 50 years had a first diagnosis of CRC, which was 15.6% of the 67,921 adults of all ages with CRC. Claims for MSI or IHC for MMR proteins within 120 days of initial diagnosis were done in 4,429 (41.9%) patients and referral to genetics services/counseling within 1 year of initial diagnosis were done in 443 (4.1%) patients. Among metastatic CRC patients, KRAS, NRAS, or BRAF tumor mutational analyses within 120 days of initial diagnosis were documented in 323 (31.5%). The median TTS ranged from 7 to 15 days with no statistically significant differences based on geographic region or health insurance plan type. Conclusions: Younger patients with early onset CRC had low rates of referral to genetics services, tumor MSI or IHC for MMR proteins testing, and KRAS, NRAS, and BRAF mutational analysis. There were no geographic or insurance type trends in TTS in non-metastatic colon cancer patients. Although underreporting is possible in our study, the findings of low utilization of genetic services and tumor genomic testing in these younger patients with early onset CRC should alert the oncology community to critical management gaps in the care of this population.
Trends in obesity among patients registered to SWOG cancer clinical treatment trials.
Authors: Vaidya Riha , Till Cathee , Greenlee Heather , Hershman Dawn L. , Unger Joseph M. 
Published: October 2020

126 Background: Rising obesity rates have been documented in the United States population since the 1980s. Several studies have shown links between obesity and the incidence of – and the outcomes of – specific cancer types. Few studies have examined the prevalence of obesity among cancer patients at the time of diagnosis or among those who participate in clinical trials. We examined the prevalence of obesity over a 35-year period among patients enrolled in clinical treatment trials conducted by the SWOG Cancer Research Network. Methods: We analyzed body mass index (BMI) at registration among patients enrolled in phase II or III clinical trials conducted by SWOG. Adult patients (age≥18) participating in trials in obesity-related cancers between 1985 and 2020 were included. Obesity was classified as BMI ≥ 30 kg/m2. Multivariable logistic regression was used to examine time trends, adjusting for age, sex, race, and treatment type. Time was defined as year of enrollment and examined in separate models as continuous years and as 5-year intervals. We examined trends among patient subgroups by sex and by treatment type (chemotherapy, immunotherapy, and targeted therapy). Results: 16,374 patients enrolled in SWOG clinical trials conducted between 1985 and 2020 were analyzed. Patients were most commonly enrolled in trials for breast cancer (n = 6,327, 38.6%), colon cancer (n = 2,408, 14.7%), multiple myeloma (n = 2,112, 12.9%), and rectal cancer (n = 1,785, 10.9%). Overall, 32% of patients were obese (n = 5,252). Unadjusted obesity rates among trial participants increased from 18% in 1985-1990 to 42% in 2016-2020, compared to an increase from 23% to 42% among US adults over a similar period. Obesity prevalence rates increased over time for all sex, age, and race subgroups. Overall, there was an increasing linear trend in obesity (OR = 1.36 for each 5-year increase, 95% CI: 1.33-1.39, p < .0001). These trends persisted with adjustments for age, sex, race, and treatment type (OR = 1.35 per 5-year increase, 95% CI: 1.31-1.39, p < .0001). Positive linear trends in obesity prevalence were observed for all subgroups by sex and treatment type. There was no evidence of difference in trends between males and females or between the three treatment types. Conclusions: We observed an increasing trend in obesity among patients participating in clinical trials for obesity-related cancers, mirroring US adult obesity rates. Our findings indicate good representation of obese patients in clinical treatment trials, which has favorable implications for the applicability of trial findings to this group of patients.
Treatment sequence, hospital practice patterns, and completion of multimodality therapy for locally advanced gastric cancer.
Authors: Portuondo Jorge Ignacio , Tran Cao Hop Sanderson , Massarweh Nader Nabile 
Published: October 2020

14 Background: Optimal oncologic care for patients with locally advanced gastric cancer includes multimodality therapy (MMT). While both perioperative chemotherapy and postoperative chemoradiotherapy are recommended, it is unclear whether one approach is more effective for ensuring patients complete MMT. Methods: National cohort study of 5,450 patients with locally advanced gastric cancer (i.e.: ≥cT2 and/or cN+) treated at 983 hospitals within the National Cancer Data Base (2006-15). Patients were categorized as having surgery first or chemotherapy first (patients not undergoing resection after chemotherapy or not receiving adjuvant after surgery were included based on intent-to-treat). MMT was defined as surgical resection with either neoadjuvant chemotherapy or adjuvant chemoradiotherapy. Hospitals were categorized into terciles based on utilization of chemotherapy first: 1.) predominantly chemotherapy first; 2.) mixed pattern; 2.) predominantly surgery first. The association between patient-level treatment, hospital practice pattern, and MMT completion was evaluated using multivariable hierarchical regression and the association with overall risk of death using multivariable Cox shared frailty modeling. Results: Overall, 55.5% of surgery first and 64.8% of chemotherapy first patients completed MMT (p<0.001) and five-year survival for those completing MMT was 45.5% and 46.6%, respectively (log-rank, p=0.91). At the patient-level, chemotherapy first was significantly associated with MMT completion (Odds Ratio [OR] 1.61 [1.39– 1.86]). By comparison, relative to mixed hospitals, care at surgery first hospitals was associated with MMT completion (OR 1.32 [1.08 – 1.59]), which was due to differences in case-mix and the proportion of patients not receiving resection after chemotherapy (surgery first hospitals—4.1%; mixed hospitals—19.0%; chemotherapy first hospitals—29.4%, p<0.001). MMT by either approach was associated with lower risk of death (ref—surgery only; chemotherapy first – Hazard Ratio [HR] 0.77 [0.68 – 0.86]; surgery first – HR 0.77 [0.68 – 0.87]) while hospital practice pattern was not. Conclusions: The type of MMT strategy is less important than ensuring patients complete MMT. After accounting for treatment drop-outs (which are substantial with either strategy), chemotherapy first appears more effective in the general community for ensuring patients complete MMT. National guidelines should be modified to emphasize neoadjuvant over surgery first MMT strategies.
The impact of within-visit and pre-visit decision aids for localized prostate cancer on patient knowledge.
Authors: Tilburt Jon Charles , Pacyna Joel E , Cina Kristin , Petereit Daniel G. , Kaur Judith Salmon , Storrrick Elizabeth M. , Zahrieh David , Dueck Amylou C. , Kim Simon P. 
Published: October 2020

151 Background: Decision aids (DAs) for prostate cancer treatment can improve knowledge and reduce decisional conflict, but the relative effect of pre-visit and within-visit DAs is not known, and effect sizes for minority populations has not been estimated. Methods: We conducted a 3-arm, patient-level-RCT in specialty urology and radiation oncology practices in Ohio, South Dakota, and Alaska, test the effect of pre-consultation and with-in consultation decision aids on patient knowledge immediately after specialty consultation compared to usual care. We used linear regression to estimate effects of each intervention arm, including the respective standard error, two-sided 95% confidence interval, and two-sided P value for testing the study’s hypotheses. Results: 103 patients were recruited and randomized to receive either the pre-visit decision aid, within-visit decision aid, or neither decision aids (usual care). In 2017 and 20018, we accrued similar numbers of men to pre-consultation aid (n = 37), during-consultation aid (n = 33) and usual care arms, respectively (n = 33). The median (range) age in years was 64 [49, 81]; 67.6% were White, 15.7% were Black or African American, 16.7% were American Indian or Alaska Native, and 1% were not reported. 47.6%, 45.6%, and 6.8% had a baseline clinical stage of T1, T2, and T3, respectively. The median [range] prostate specific antigen (PSA) was 8.0 [2.4, 53.7]. There were no clinically notable imbalances. We obtained usable data on 102 of the 103 patient-participants. The pre-visit decision aid arm showed a mean knowledge effect of 0.694 (0.636, 0.753). The within-visit decision arm showed a very similar mean knowledge effect of 0.686 (0.625, 0.748). The usual care arm showed a mean knowledge effect of 0.644 (0.582,0.705). The linear regression model showed, that, compared with usual care, neither intervention effect achieved statistical significance in the primary analysis (p = 0.24, 0.330, for pre-visit and within-visit, respectively). Conclusions: Modest knowledge gains of pre-visit and during-visit decision aids for prostate cancer treatment were not statistically significant. Clinical trial information: NCT03182998 .