bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differential survival after prostate cancer by race: Role of NCI-designated comprehensive cancer centers
Authors: Sun C. , Kurian S. , Washington G. , Nielsen-Menicucci K. , Wilson T. , Crocitto L. , Donald S. , Hanby C. , Landier W. , Smith S. , Bhatia S. 
Published: August 2020

6520 Background: A significant gap exists between Caucasians and African-Americans (AAs) in prostate cancer mortality, possibly due to sociodemographics, disease biology, or treatment. Furthermore, differential access to care at NCI-designated Comprehensive Cancer Centers (NCICCCs) conceivably contributes to this difference. Methods: Using data from the Los Angeles Cancer Surveillance Program, we studied the underlying causes of differences in mortality in 18,790 men (AAs: 4,211; Caucasians: 14,579) diagnosed with prostate cancer between 1998 and 2003, and followed until 2006. Three NCICCCs serve this area: USC-Norris, UCLA-Jonsson, and City of Hope. Results: Median age at diagnosis was 67.5 yrs; AAs were significantly more likely to have lower SES; carry no insurance; have distant disease; and be managed with “watchful waiting.” The overall and prostate-specific survival was significantly superior for patients treated at NCICCCs, and for Caucasians (Table). Multivariate analysis, after adjustment for sociodemographics, race, insurance, tumor-related factors, and treatment-modality, revealed that treatment at NCICCCs was associated with lower overall (HR=0.74, 95% CI=0.6–0.9) and prostate-specific mortality (HR=0.69, 95% CI=0.5–0.97). AAs were less likely to utilize NCICCCs (OR=0.42, 95%CI=0.4–0.5). Finally, adjustment for sociodemographic, tumor/treatment-related factors, and treatment site abrogated the racial difference in overall (HR=1.08, 95%CI=0.99–1.2) and prostate-specific (HR=1.11, 95%CI=0.9–1.3) mortality. Conclusions: Patients treated at NCICCCs have lower mortality compared with other facilities. AAs are less likely to utilize NCICCCs for prostate cancer. AAs and Caucasians have comparable overall and prostate-specific survival, after adjustment for sociodemographic, tumor/treatment-related factors, and treatment site. Future studies are needed to understand barriers and facilitators to utilization of NCICCCs for management of prostate cancer. [Table: see text] No significant financial relationships to disclose.
Integrating cancer care: Patient and practice management processes among surgeons who treat breast cancer
Authors: Katz S. J. , Hawley S. T. , Griggs J. J. , Morrow M. , Hofer T. P. 
Published: August 2020

6526 Background: The Institute of Medicine has called for cancer care models that parallel those underway to integrate the management of patients with chronic conditions. The objective of this study was to evaluate patterns and correlates of such initiatives in the practices of surgeons treating women with breast cancer. Methods: We developed 5 multi-item scales to describe breast cancer patient and practice management processes based on the Chronic Care Model (multidisciplinary clinician communication; availability of clinical information; patient decision support; access to information technology; and practice management initiatives). We then performed a survey among attending surgeons of a population-based sample of patients diagnosed with breast cancer during a period from June 2005-February 2007 in metropolitan Los Angeles and Detroit (N = 312, response rate 76.1%). We evaluated the distribution of management process measures across selected characteristics of providers and practices. Results: About half of the surgeons devoted 15% or less of their total practice to breast cancer; while 16.2% of surgeons devoted 50% or more. The deployment of management processes varied markedly with most surgeons reporting low use. For example, only about 10% of surgeons indicated that half or more of their patients were exposed to multidisciplinary physician communication; while only 5% indicated that half or more of their patients were provided decision and care support services such as attending a presentation or viewing a video about breast cancer prior to surgery or attended a patient support group. Management process measures were positively associated with greater levels of surgeon specialization and the presence of a teaching program. Cancer program status (NCI center, ACS cancer program, neither) was weakly associated with any of the management process measures. Conclusions: The low uptake of patient and practice management processes observed in this study suggests that breast surgeons are not convinced that these processes matter or that there are logistical and cost barriers to implementation. More research is needed to understand how variation in patient and practice management processes may affect the quality of care for patients with breast cancer. No significant financial relationships to disclose.
Costs of treatments for local/regional prostate cancer
Authors: Snyder C. F. , Frick K. D. , Blackford A. L. , Herbert R. J. , Neville B. A. , Carducci M. A. , Earle C. C. 
Published: August 2020

6527 Background: Men with prostate cancer have a variety of treatment options, including surgery, radiation, hormonal therapy, combinations thereof, or active surveillance. Treatment choice may have important cost implications. Methods: Using the SEER-Medicare database, we examined the Inpatient, Outpatient, Emergency, and Other costs of men diagnosed with local/regional prostate cancer in the year 2000 who were 66+ years old and enrolled in the fee-for-service Medicare program. Based on the treatments received in the first 9 months from diagnosis, men were assigned to these treatment groups: active surveillance, radiation, hormonal, hormonal+radiation, surgery (might also include radiation and hormonal therapy). We matched the prostate cancer cases to noncancer controls on age, race, sex, SEER region, comorbidity, and survival. We estimated the costs of prostate cancer care from 1 month pre- to 12 months post-diagnosis by calculating the incremental costs of care for cases vs. controls. Costs of care were estimated using Medicare payments. Results: 13,769 prostate cancer cases were matched with 13,769 controls and allocated to these treatment groups: active surveillance (n=2,805), radiation (n=2,582), hormonal (n=2,190), hormonal+radiation (n=3,992), and surgery (n=2,200). The most expensive treatment group was hormonal+radiation, with cases having a total average incremental cost of $17,795 vs. controls, followed by surgery ($15,467), radiation ($12,326), and hormonal therapy ($10,804). Active surveillance was the least expensive ($4,152). Outpatient costs were the major driver of increased costs for the hormonal+radiation group. Increased costs for surgery patients were driven by both Outpatient and Inpatient costs. Emergency Department and Other costs were generally similar between prostate cancer cases and controls. Conclusions: The treatment choice of men with local/regional prostate cancer has important implications for cost in the year following diagnosis. Additional analyses exploring long-term costs are needed. [Table: see text] No significant financial relationships to disclose.
Prevention of hip fractures in older men receiving androgen deprivation therapy for prostate cancer: A cost-effectiveness analysis
Authors: Ito K. , Elkin E. , Morris M. 
Published: August 2020

6530 Background: Androgen deprivation therapy (ADT) increases the risk of osteoporotic fractures. Our goal was to assess the cost-effectiveness of bone mineral density (BMD) screening followed by alendronate therapy at the onset of ADT in men with T2c-T4N0 prostate cancer. Methods: We developed a Markov model of prostate cancer progression and simulated the experience of 70-year-old men with T2c-T4N0 prostate cancer starting a 2-year course of ADT after radiation therapy. We compared four strategies: No BMD screening and no alendronate therapy; BMD screening with alendronate therapy for men with osteoporosis (a T-score ≤ -2.5); BMD screening with alendronate therapy for men with osteoporosis or osteopenia (a T-score ≤ -1.0); and universal alendronate therapy without BMD screening. The main outcome measure was cost per quality-adjusted life year (QALY) gained. Data sources were U.S. epidemiological studies and health care cost figures. A model-based estimate of median survival was 9.5 years. Proportions of men who had a T-score ≤ -2.5 and -1.0 were 10% and 45%, respectively. A model-based incidence of hip fractures with no therapy was 0.93 per 100 person-years. Alendronate reduced the risk of hip fractures by 10%. Results: Compared with no screening and no therapy, BMD screening with alendronate therapy for men with osteopenia or osteoporosis cost $66,100 per QALY gained. BMD screening with alendronate therapy only for those with osteoporosis was slightly more costly and more effective, but had a less favorable ICER. Universal alendronate therapy without screening cost $1,580,300 per QALY gained. These results were most sensitive to assumptions about the impact of alendronate on the rate of BMD loss during ADT and the price of alendronate. Conclusions: In men with T2c-T4N0 prostate cancer, BMD screening with alendronate therapy for men with osteoporosis or osteopenia is a cost-effective use of resources, compared with other medical interventions in oncology. [Table: see text] No significant financial relationships to disclose.
The effect of a cancer diagnosis on disability status
Authors: Habermann E. B. , Virnig B. A. , McGovern P. M. , McBean A. M. , Alexander B. H. , Baxter N. N. 
Published: August 2020

6531 Background: Although cancer and cancer treatments may lead to an inability to work, working-age adults eligible for Medicare benefits on the basis of disability face a 29-month waiting period between initial application due to disability and enrollment in the program. In this study we evaluated patterns of Medicare enrollment for working-age adults with cancer and determined factors predicting enrollment. Methods: The Surveillance, Epidemiology, and End Results (SEER) and SEER-Medicare data were used for this retrospective cohort analysis. We included patients age 21 to 59 diagnosed with lung, prostate, colorectal, and breast cancer (female) cases from 1992 through 2002. Patients were followed until 2005 or death. We constructed line plots of time from cancer diagnosis to enrollment in Medicare due to disability, anticipating a spike in enrollment around 29 months post-diagnosis. We compared demographic and tumor characteristics in the disabled to the all similarly aged patients included in SEER. We used logistic regression to determine factors associated with enrollment in Medicare due to disability 29 to 35 months post-diagnosis including demographic characteristics, stage at diagnosis, and type of surgical treatment. Results: We identified 359,049 working-age adults who were diagnosed with prostate, lung, colorectal, or female breast cancer. Within 5 years of diagnosis, 4.4% had enrolled in Medicare due to disability, most between 29 and 31 months post-diagnosis (the earliest time period of eligibility on the basis of cancer diagnosis). Later stage at diagnosis, lack of surgical treatment, aggressive surgical treatment, unmarried marital status, Hispanic or African American race/ethnicity, older age, and male gender were associated with statistically significantly higher odds of enrollment in Medicare due to disability. Conclusions: A significant number of working-age cancer patients become eligible for enrollment in Medicare due to disability. Most become eligible between 29 and 31 months after diagnosis indicating that cancer and/or treatment had a substantial permanent impact on ability to work from the time of diagnosis. Federal policy offering Medicare benefits only 29 months after application should be reevaluated. No significant financial relationships to disclose.
Cardiometabolic risk in survivors of childhood cancer who received hematopoietic cell transplant (HCT)
Authors: Baker K. S. , Kelly A. S. , Petryk A. , Sinaiko A. R. , Steffen L. M. , Moran A. , Mulrooney D. , Dengel D. R. , Gujral K. , Zhou X. , Steinberger J. 
Published: August 2020

6532 Background: Evidence suggests that survivors of childhood cancer are at increased risk for cardiovascular disease (CVD) and type 2 diabetes with even higher risk in those who received HCT. The purpose of this study was to compare the cardiometabolic risk factor profile in HCT patients and healthy sibling controls. Methods: Measures of insulin resistance (euglycemic hyperinsulinemic clamp adjusted for lean body mass [Mlbm], low Mlbm represents insulin resistance), fasting glucose, insulin, lipids, anthropometry, blood pressure (BP), and carotid artery compliance and distensibility (lower values represent arterial stiffness) were determined in 87 children and young adults (current age 27.3 yr, 57% male) who had received HCT for hematologic malignancy during childhood (mean age at HCT 11.8 yr) and 55 healthy sibling controls (current age=25.2 yr, 51% male). Linear regression models were used to evaluate risk factors between groups after adjusting for age, gender, pubertal stage, body mass index (BMI), and carotid lumen diameter (stiffness measures only). Results: Metabolic syndrome (ATP III criteria for adults, modified criteria for children) was present in 13 (14.9%) HCT survivors and 4 (7.3%) controls (p=0.19). Thirty-one (35.6%) survivors and 9 (16.4%) controls had two or more components of the metabolic syndrome (p=0.11). There were no differences between groups for BMI, waist circumference, percent body fat, or BP. HCT survivors had higher triglycerides, fasting glucose and insulin, lower HDL cholesterol, arterial distensibility, and were more insulin resistant (Table). Conclusions: HCT survivors have increased cardiometabolic risk factors independent of obesity suggesting that cancer itself and/or associated treatment exposures have a direct influence on CVD risk and that early screening and management of cardiometabolic risk factors should be considered in HCT survivors. [Table: see text] No significant financial relationships to disclose.
Adequacy of published oncology randomized controlled trials to provide details needed for clinical application
Authors: Duff J. M. , Leather H. L. , Walden E. O. , LaPlant K. D. , George T. J. 
Published: August 2020

6536 Background: Randomized control trials (RCTs) provide evidence for life-saving and supportive therapies. Although manuscript submissions follow a standard scientific format, major oncology journals have minimal standards for reporting treatment administration. Published data investigating chemo and biologic therapy often lack details needed for effective and safe clinical application. Methods: All therapy-based phase III oncology RCTs published between 2005–2008 in the Journal of Clinical Oncology (JCO), The New England Journal of Medicine (NEJM), Journal of the National Cancer Institute (JNCI), Blood, and Cancer were eligible for inclusion. Physicians and oncology pharmacists were surveyed for details needed for clinical practice. Each article was evaluated for these mandatory elements ( Table ). Differences were calculated using the Chi-squared test. Results: Literature search identified 339 eligible articles, 77 were reviews or meta-analyses. 262 were included in the final analysis (165 JCO; 31 NEJM; 27 Cancer; 20 JNCI; 19 Blood). Only 31 (12%; median score 7.3) met the main objective of complete data reporting. The most consistently reported and missing elements are described in Table 1. Premedications, growth factor support, and dose adjustments for hematologic or organ toxicity were reported less than half the time (p<0.0001). The presence of an online appendix did not significantly improve the results (data not shown). Conclusions: RCTs published in top tier oncology journals fail to consistently report full details needed for clinical application. Manuscript submission guidelines should be modified to promote consistent reporting with potential use of online appendices. Standardized editorial policy may allow safe and effective translation of trial drug findings into clinical practice. [Table: see text] No significant financial relationships to disclose.
Racial differences in the use of contralateral prophylactic mastectomy among women undergoing BRCA1/BRCA2 genetic testing
Authors: Ready K. , Gutierrez-Barrera A. M. , Litton J. , Meric-Bernstam F. , Gonzalez-Angulo A. M. , Hortobagyi G. , Arun B. 
Published: August 2020

6542 Background: Patients often use both positive and negative BRCA1/BRCA2 genetic test results to aid in surgical management decisions, but little is known about the existence of racial/ethnic differences in the use of genetic test results. The objective of this study was to evaluate differences in rates of contralateral prophylactic mastectomy (CPM) by race. Methods: A retrospective chart review was performed. Women with a personal history of breast cancer who underwent genetic testing for the BRCA1 and BRCA2 genes at our institution between 1996 and 2008 and were eligible for CPM were included in the study. Genetic test result, race/ethnicity as reported by the patient, years of follow-up since receipt of test result, and decision regarding CPM were recorded. Pearson chi square analyses and Fisher's exact tests were performed to test for significance. Results: 881 women were included in the study. Twenty percent (n = 180) were found to have a BRCA1 or BRCA2 mutation, while 80% (n = 701) were found to have an uninformative negative result. The study population was 87% (n = 771) Caucasian; 7% (n = 58) African American; and 6% (n = 52) Hispanic. Median follow up time was 3 years. There were no significant differences in either follow up time or percentages of BRCA positivity, based on race/ethnicity. Among those with a positive result, 45% (67/149) of Caucasians, 33% (5/15) of African Americans, and 50% (8/16) of Hispanics underwent CPM, but this was not statistically significant. Caucasians and Hispanics with positive results were significantly more likely than their counterparts with negative results to undergo CPM (Caucasians, 45%; 67/149 vs. 16%; 101/622; p<.001; Hispanics, 50%; 8/16 vs. 11%; 4/36; p = 0.004), but this same trend was not observed among African Americans (positive results, 33%; 5/15 vs. negative results, 14%; 6/43; p = 0.10). Conclusions: Among those with a BRCA1/BRCA2 mutation, there does not appear to be any significant difference in the use of CPM based on race/ethnicity. However, Caucasians and Hispanics appear to be more likely than African Americans to use the results of genetic testing to make surgical management decisions. No significant financial relationships to disclose.
Quality of care for breast cancer patients in Japan: An analysis of the Japanese Breast Cancer Registry
Authors: Mukai H. , Higashi T. , Iwase T. , Sobue T. 
Published: August 2020

6547 Background: In Japan, growing concern that patients do not receive optimum care led to the enactment of the Cancer Control Act in 2006, which mandates the government to undertake initiatives in ensuring the quality of cancer care. Here, we evaluated the current status of breast cancer care in Japan using process-of-care quality indicators (QIs) for breast cancer care. Methods: Combining clinical evidence and expert opinion, we developed 45 QIs covering the continuum of breast cancer care from initial evaluation to follow-up. Each QI describes standards of a particular aspect of care, and its score is calculated as the percentage of applicable patients who received the recommended care (adherence score). Of the 45 QIs, 7 could be scored using data in the Japanese Breast Cancer Registry, which covers about 40% of all Japanese breast cancer patients and has been continuously maintained since 1975. Results: The study population included 15,227 patients registered by 224 facilities in 2005. On average, patients received 72.1% of recommended care. However, substantial variation in adherence was seen across QIs (21–98%). Adherence score was less than 85% in five of seven QIs. Variation across facilities was observed in six QIs. Conclusions: The quality of breast cancer care in Japan has room for improvement in many aspects of care. Although the amount of data in the cancer registry suitable for quality assessment is limited, it is useful in detecting quality problems. [Table: see text] No significant financial relationships to disclose.
Trends in the application of dynamic allocation methods in multiarm cancer clinical trials
Authors: Pond G. R. , Tang P. A. , Welch S. A. , Chen E. X. 
Published: August 2020

6550 Background: In multiarm oncology clinical trials there is always a risk that the treatment groups could be imbalanced for a prognostic factor, potentially biasing treatment comparisons and compromising the validity of the results. Stratified randomization (SR) is frequently used to reduce imbalances. Dynamic allocation (DA), also known as minimization, is a controversial and largely nonrandom method of treatment allocation that can incorporate more prognostic factors than traditional SR methods. Proponents argue that results from clinical trials implementing DA are potentially more credible, while opponents claim there is little added benefit, increased complexity, and the statistical properties are not fully understood. We reviewed multi-arm cancer trials published between 1995–2005 to describe trends in the application of DA methods. Methods: 476 clinical trials with at least 100 patients in each arm, published in 13 major journals were reviewed. Manuscripts were grouped by impact factor (IF) of the publishing journal into low (<10), medium (10–20) and high (20+) categories. Trial-specific factors associated with publication were collected along with details of allocation method. Results: 112 (24%) trials described using DA for assigning patients to treatment. 79% of trials employing DA methods included 3 or more stratification factors, compared with only 36% of other trials (p < 0.001). Reported use of DA was similar between industry and non-industry sponsored studies (p = 0.85) and by geographical region (p = 0.73). Of 364 trials which did not describe using DA, 103 (28%) reported using SR, but a statement describing stratification on at least one factor was included in 291 (80%) trials. A trend was observed that reported use of both DA (p = 0.072) and SR (p = 0.067) methods increased over time. DA was associated with publication in higher IF journals univariately (OR = 1.67, 95% CI 1.11–2.52, p=0.014) and after adjusting for identified prognostic factors (OR = 1.70, 95% CI 1.06–2.73, p = 0.028). No association between SR and higher IF journal publication was observed (p = 0.52 univariately and p = 0.44 adjusting for other factors). Conclusions: DA is frequently used in cancer clinical trials. Reported use of DA, but not SR, is associated with publication in high IF journals. No significant financial relationships to disclose.