bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of ARMS-qPCR on detection sensitivity of earlier diagnosis of papillary thyroid cancers with worse prognosis determined by BRAF V600E and TERT promoter mutation coexisting.
Authors: Yu Peng-cheng , Tan Li-cheng , Shi Xiao , Ma Ben , Wei Wen-jun , Wang Yu , Ji Qing-hai , Wang Yu-long 
Published: May 2020

6588 Background: Co-existing of BRAF V600E and TERT promoter C228T/C250T mutation has been extensively related to prognosis in thyroid cancer. Our study aimed to establish a more sensitive method for mutation detection and explore the correlation more in-depth. Methods: BRAF and TERT promoter mutation status of 250 papillary thyroid cancer was detected by both Amplification Refractory Mutation System quantitative PCR (ARMS-qPCR) and Sanger sequencing to compare the sensitivity. The associations between the mutation status and the clinicopathological features were analyzed. Results: ARMS-qPCR displayed higher sensitivity than Sanger ( BRAF V600E: 75.2% vs. 52.4%, p< 0.001; TERT promoter C228T/C250T: 12.0% vs. 3.6%, p= 0.001; Co-mutation (9.6% vs. 3.2%, p= 0.005). Both methods indicated that patients with BRAF V600E and TERT promoter co-mutation were higher in age at diagnosis (ARMS-qPCR: 51.0 ± 14.2 vs. 40.2 ± 12.6, p <0.001; Sanger: 64.3 ± 7.1 vs. 40.5 ± 12.6, p <0.001), and the recurrence rate (16.7% vs. 3.1%, p= 0.014; 50.0% vs. 2.9%, p< 0.001), besides, the co-mutation group were related to more advanced TNM stage ( p< 0.001; p< 0.001) and higher MACIS score (5.1 ± 1.5 vs. 4.2 ± 0.7, p= 0.006; 6.6 ± 1.1 vs. 4.2 ± 0.8, p< 0.001). In addition, compared with the co-mutation results of Sanger, it seems that ARMS-qPCR has identified an earlier stage of group, which were younger (43.3 ± 10.1 vs. 66.4 ± 6.1, p< 0.001), and with smaller tumor (1.8 ± 1.5 vs. 4.0 ± 1.3, p= 0.002), as well as lower recurrence rate ( 0.0% vs. 50%, p= 0.007). Besides, the newly identified group were lower in MACIS score (4.2 ± 0.8 vs. 6.9 ± 0.7, p= 0.002) and with lower TNM stage ( p= 0.001). Conclusions: Patients with BRAF V600E and TERT promoter C228T/C250T co-mutation have a worse prognosis. Using ARMS-qPCR, the more sensitive method could identify earlier stages of patients with a potentially worse prognosis. [Table: see text]
Benefits of an early mobility program for hospitalized cancer patients: A pilot study.
Authors: Smith Cardinale B. , Gunning Melissa , Hubman Margie , Conklin Christine , Wells Nicole , Theroux Haley Hines , Liu Mark , Wolfe Jennifer 
Published: May 2020

7008 Background: Cancer patients are often hospitalized with complications from cancer and cancer treatment. Many experience a decline in physical functioning which likely contributes to increased length of stay (LOS) and excess days, increased readmissions and decreased patient experience. We aimed to determine whether a mobility program project would improve quality of care and decrease healthcare utilization. Methods: We implemented a mobility aide program on an oncology unit in a large academic medical center between April 2, 2019 to December 31, 2019. The program consisted of nursing evaluation using the Activity Measure for Postacute Care (AMPAC), an ordinal scale ranging from bed rest to ambulating ≥250 feet, was used to quantify mobility. Plan of care was determined in a multidisciplinary manner with physical therapy (PT), nursing and a mobility aide, a medical assistant with enhanced rehabilitation training. Patients were then mobilized two times per day seven days a week. Using descriptive statistics we evaluated the programs impact on excess days, readmissions, changes in mobility and patient experience as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) during this time period compared to the 6 month interval prior to implementation. Results: During the study interval, 988 patients were admitted and received the mobility program. There was a 6% reduction in excess days (p = 0.04). Similarly, readmission rates decreased from 25% to 19% (p = 0.03). Overall 76% of patients wither maintained or improved their mobility score. During this time period HCAHPS scores (willingness to recommend hospital) increased from 63% at baseline to 91% (p = 0.01). Conclusions: Use of this mobility program resulted in a significant decrease in healthcare utilization and improvement in patient experience. This demonstrates that non-PT professionals can mobilize hospitalized cancer patients decreasing the burden of PT and nursing resources. Future work will evaluate the sustainability of the program and evaluate association with healthcare costs.
Going off pathway: Problem or good care?
Authors: Edge Stephen B. , Liu Lu , Stefaniak Nessa , Murphy Monica L. , Thompson James E. , Hillengass Jens , Dy Grace K. , Kuvshinoff Boris W. , McKinney Mishellene 
Published: May 2020

7014 Background: Clinical oncology pathways (COP) provide decision support and benchmarking against national standards. Some organizations provide financial incentives for using COP-recommended treatment (on pathway: OnP). Treatment (Rx) other than COP recommended Rx (off pathway: OffP) is appropriate for some cases. There are limited data on the appropriateness of OffP Rx. This study examines rates and reasons for OffP Rx in one cancer center. Methods: All systemic Rx decisions entered in the ClinicalPath COP from 10/1/18 - 9/30/19 were classified as OnP (including Rx on a clinical trial) or OffP and as adjuvant/neoadjuvant therapy (ADJ) or for metastatic cancer (MET). Oncologists must provide free text reasons for OffP Rx. Records of all OffP care were reviewed by a senior nurse-led team and physician to verify and classify OffP reasons. Cases without clear documentation were referred to the treating oncologist and/or multidisciplinary team for review. Justified OffP reasons (R1-6) were classified as: R1. Documented drug toxicity and/or treatment-limiting co-morbidity; R2. Prior treatment precluding pathway Rx; R3. New drug indication or molecular targeted therapy not in COP; R4. Continuation of Rx started prior to referral; R5. Other clearly documented and reviewed provider or multidisciplinary team rationale; and R6. Patient preference. Results: There were 2,997 COP treatment decisions for 2,389 patients. The OnP rate was higher for ADJ than for MET Rx (87% vs. 78%). Non-justified OffP care accounted for 1% of cases. 69% of OffP Rx was because of known drug toxicity, co-morbidity limiting therapy, prior therapy precluding COP choice, and new drug indications (Table). Conclusions: COPs provide decision support and practice benchmarking. Lower OnP rates for MET Rx likely reflect the nuances of Rx for advanced cancer. Most OffP care was justified and appropriate. Financial incentives that focus on the percentage of COP OnP care could paradoxically harm the quality of care, especially given the high percentage of OffP decisions for reasons of drug toxicity, co-morbidity and new drug indications. [Table: see text]
Subjective cognition in chimeric antigen receptor T-cell therapy recipients.
Authors: Barata Anna , Hoogland Aasha , Hyland Kelly , Kommalapati Anuhya , Jayani Reena , Irizarry-Arroyo Nathalie E. , Rodriguez Yvelise , Alla Raviteja , James Brian , Lafranchise Elizabeth , Jain Michael D. , Locke Frederick Lundry , Jim Heather S.L. 
Published: May 2020

7020 Background: Chimeric antigen receptor T-cell (CAR-T) therapy can lead to durable responses in chemorefractory patients with hematologic malignancies. CAR-T, however, can be associated with neurotoxicity. There is a significant body of literature describing patient-reported concerns with cognition in hematopoietic cell transplant (HCT) recipients, a similar treatment group. However, little is known about subjective cognition in CAR-T patients. This study examined changes in subjective cognition over time in CAR-T recipients and compared their outcomes with allogeneic HCT recipients. Methods: At baseline and 90 days after infusion, participants completed the Everyday Cognition Questionnaire (ECog). The ECog provides scores for total cognition, memory, language, visuospatial abilities, planning, organization, divided attention, and satisfaction with cognition. Comparison data from allogeneic HCT recipients came from a previous observational study. Linear mixed models compared changes in subjective cognition between recipients of CAR-T and allogeneic HCT over time. Models were adjusted by age, marital status, education, and Karnofsky performance status. Results: Participants were 111 CAR-T recipients (mean age 60 years, 37% female) and 190 allogeneic HCT recipients (mean age 53, 42% female). Linear mixed models indicated CAR-T recipients’ subjective cognition didn’t change within the 90 days after infusion (p’s > .05). At baseline, there were no group differences between CAR-T and allogeneic HCT recipients in subjective cognition (p’s > 0.05). Over time, however, subjective cognition between groups differed. Specifically, CAR-T recipients reported stable subjective cognition whereas allogeneic HCT recipients reported worsening total subjective cognition (p = 0.04), memory (p = 0.02), visuospatial abilities (p = 0.01), planning (p = 0.01), and divided attention (p = 0.01). At follow-up, CAR-T recipients reported better total subjective cognition (p < 0.01), memory (p < 0.01), language (p = 0.01), visuospatial abilities (p < 0.01), planning (p < 0.01), and divided attention (p < 0.01) than allogeneic HCT recipients. Conclusions: Despite the neurotoxicity associated with CAR-T, patients can expect to perceive similar subjective cognition at day 90 compared to baseline. Future studies should also evaluate objective cognition in CAR-T recipients.
Global perspectives on clinical cancer research: A comparison of randomized controlled trial (RCT) design and outcomes across high income and low-middle income countries.
Authors: Wells Connor , Sharma Shubham , Del Paggio Joey C. , Hopman Wilma M. , Gyawali Bishal , Pramesh CS , Sullivan Richard , Booth Christopher M. 
Published: May 2020

7021 Background: Cancer clinical trials have become increasingly international in scope. There are limited data regarding trial variation based on the economic status of the country in which they are conducted. Here we describe trial characteristics, design, and results of all RCTs published globally during 2014-2017. Methods: A structured literature search was designed using PUBMED to identify all RCTs evaluating anti-cancer therapies published during 2014-2017. Data captured included authorship, participants, study characteristics, design, and results. RCTs were classified based on the World Bank country-level economic classification of the first author [low-middle/upper-middle income countries (LMIC) and high-income countries (HIC)]. Among superiority RCTs that met the primary endpoint (i.e. statistically “positive”), we calculated the ESMO-MCBS to identify trials with substantial clinical benefit (MCBS scores 4/5 or A/B). Outcomes were compared with Chi Square or Fisher’s Exact tests. Results: The study cohort included 694 RCTs; 636 (92%) were led by HIC and 58 (8%) were led by LMIC. Compared to LMIC, RCTs in HICs were more likely to be funded by industry [73% vs 41%, p<0.001] and more likely to test novel systemic therapies [87% vs 78%, p=0.027]. LMIC studies were typically smaller (median N=220 vs N=474 participants, p<0.001) and more likely to meet their primary endpoints [66% vs 44%, p=0.002]. In “positive” superiority trials, the effect size was larger in LMICs compared to HICs (median HR 0.62 vs HR 0.84, p<0.001). The proportion of trials identifying treatments with substantial clinical benefit (ESMO MCBS 4/5/A/B) was 45% (LMIC) and 31% (HIC, p=0.291). Studies from LMIC were published in journals with lower impact factors (IF) (median IF 7 vs 21, p<0.001); a publication bias persisted when adjusted for whether a trial was positive or negative: median IF LMIC negative trial=5 vs HIC negative trial=18 (p<0.001); median IF LMIC positive trial=9 vs HIC positive trial= 26 (p<0.001). Conclusions: Only a small minority of oncology RCTs are led by investigators in LMIC; these trials are less likely to be funded by industry and more likely to meet their primary endpoint. “Positive” RCTs from LMIC identify therapies with a substantially larger effect size than HIC. These data identify a substantial publication bias against RCTs conducted in LMIC.
Racial disparities in immune-related adverse events (irAE) of immune checkpoint inhibitors (ICPi) and association with survival based on clinical and biochemical responses.
Authors: Peravali Monica , Gomes-Lima Cristiane , Tefera Eshetu , Baker Mairead , Sherchan Mamta , Farid Saira , Burman Kenneth D , Constantinescu Florina , Veytsman Irina 
Published: May 2020

7025 Background: ICPi cause various irAE with thyroid dysfunction as a commonly reported abnormality. There is increasing evidence showing positive association with development of irAE and survival. However, prior trials with ICPi had underrepresentation of minorities with <5% African Americans (AA). Methods: We retrospectively reviewed patients (pts) with stage IV solid malignancies treated with PD1/PDL1 blockers between 1/2013-12/2018 across MedStar Georgetown Cancer Institute facilities. Pts treated with CTLA-4 inhibitors were excluded. Progression free survival (PFS) and overall survival (OS) were primary endpoints and were calculated using Kaplan-Meier methods and Wilcoxon rank sum test for comparison. Results: 293 pts met eligibility criteria. 91 pts (31%) had any grade irAE; most common AE were endocrine (40.7%) specifically TSH elevation, dermatological (23.1%) and rheumatologic (18.7%). Proportion of irAE was significantly higher in Caucasians versus AA (60.4% vs 30.8%), in pts with low PDL1, lower LDH, older age, and those who had more treatment cycles with ICPi. Rate of progression was lower in pts with irAE (30.8% vs 46.0%, p-0.0140). Median PFS (5.8 vs 3.0 months (mo), p- 0.0204) and OS (17.1 vs 7.2 mo, p value- <0.0001) were higher with irAE. Statistically significant difference in OS (17.1 vs 8.6 mo, p- 0.0002) but not in PFS (5.8 vs 3.3 mo, p: 0.0545) was noted with endocrine irAE. No differences in survival were observed among other commonly reported irAE. Differences in survival among subgroups of pts with irAE are detailed in table. Conclusions: Development of irAE positively correlated with improved PFS and OS as reported in previous studies. To our knowledge, this is the first study observing differences in OS favoring endocrine AE and Caucasian race. These factors may be potential surrogate markers of prognosis pending replication of these results in large-scale studies. [Table: see text]
Health insurance status and cancer stage at diagnosis and survival in the United States.
Authors: Zhao Jingxuan , Han Xuesong , Nogueira Leticia , Jemal Ahmedin , Halpern Michael T. , Yabroff K Robin 
Published: May 2020

7026 Background: While previous studies demonstrated associations between Medicaid coverage or no health insurance with both advanced stage at cancer diagnosis and worse survival, access to health care in the U.S. has changed substantially in the past decade. This study examined associations of health insurance status with stage at diagnosis and survival among 17 common cancers using recent national data. Methods: We identified 1,427,532 cancer patients aged 18-64 years newly diagnosed with 17 common cancers from the 2010-2013 National Cancer Database. Multivariable logistic regression models were used to examine the distribution of stage at diagnosis by health insurance status (private, Medicare, Medicaid, dual Medicare/Medicaid, and uninsured) overall and for each cancer site. Cox models compared stage-specific survival by health insurance for each site. Results: Compared to privately insured patients, Medicaid and uninsured patients were significantly more likely to be diagnosed with advanced-stage cancer (III/IV) for all the 17 cancers combined (adjusted odds ratio [AOR]: 2.27, 95% confidence interval [95CI]: 2.24-2.29; AOR: 2.39, 95CI: 2.36-2.42, respectively) and for all included cancer sites separately. Medicare and Medicare-Medicaid patients were also more likely to be diagnosed at advanced-stage for all the 17 cancers combined, but results varied by cancer site. Compared to the privately insured patients, worse survival was observed for patients with all other insurance types and uninsured at each stage for all the 17 cancers combined and most cancer sites. For example, among patients diagnosed at stage I, adjusted mortality hazard ratios for Medicare, Medicaid, Medicare-Medicaid, and uninsured patients were 1.72 (95CI: 1.70-1.75), 1.73 (95CI: 1.71-1.76), 2.07 (95CI: 2.02-2.17) and 1.56 (95CI: 1.53-1.58), respectively, compared with privately-insured patients. Conclusions: Patients with non-private insurance were more likely to be diagnosed with cancer at advanced stage and have worse survival. Improving access to health insurance with adequate coverage is crucial for receiving appropriate cancer screening, diagnosis, and quality care.
Socioeconomic disparities in MGMT promoter methylation testing for glioblastoma patients.
Authors: Iorgulescu Bryan , Lamba Nayan , Smith Timothy R. , Reardon David A. 
Published: May 2020

7029 Background: MGMT promoter methylation holds important prognostic and predictive implications for glioblastoma (GBM) patients. Herein we evaluate whether any barriers faced MGMT testing. Methods: Adults with newly-diagnosed GBMs were identified from the U.S. National Cancer Database (2010-2016). Patient socioeconomic, tumor, and cancer program features were evaluated for association with MGMT testing by multivariable logistic regression. Results: Of 12,380 GBM patients, only 57% had MGMT testing–a rate that increased to 74% by 2016. Testing was independent of patients' sex or race/ethnicity (all p > 0.05); and was largely independent of GBM histology, size, and location. Older patients were less likely to receive testing (54% of ≥70-years-olds vs 62% of those in their 40s, p = 0.01). Insurance status was an independent predictor of testing: only 43% of uninsured patients had testing, vs 61% of privately-insured or 55% of Medicare patients (p≤0.01). The uninsured rate dropped from 3.6% in 2010 to 2.5% in 2016 and was associated with Medicaid expansion under the Affordable Care Act. Patients from non-expansion states had the lowest rates of testing (55%), vs patients from expansion states (58%, p < 0.001). Additionally, household incomes were independently associated with testing: only 50% of patients living in the poorest quartile of households had testing vs 61% in the richest quartile (p = 0.001). Diagnosing hospital type was also an independent predictor of testing: patients diagnosed at academic/NCI-designated cancer programs were most likely to have testing (65%), vs only 45% of community and 44% of comprehensive community cancer program patients were provided testing (all p < 0.001). By 2016, testing rates had improved in all program types–particularly at comprehensive community (67%) and academic (80%) programs, but lagged at community programs (56%, p < 0.001). Patients without MGMT testing received less chemotherapy (mOR = 0.66, p < 0.001) and were associated with worse overall survival (mHR = 1.08, p = 0.002). Conclusions: Newly-diagnosed GBM patients in the U.S. who were uninsured, from the poorest quartile of households, or diagnosed at community cancer programs faced significant barriers to receiving MGMT testing. Medicaid expansion under the ACA was associated with reduced uninsurance, increased Medicaid insurance, and improved rates of testing. Reduced testing rates were associated with less chemotherapy and worse OS. Together our results indicate that substantial socioeconomic and care setting disparities exist in MGMT testing for GBM patients.
Disparities by race, socioeconomic status, and insurance type in the receipt of NCCN guideline concordant care for select cancer types in California.
Authors: Clair Kiran , Chang Jenny , Ziogas Argyrios , Tanjasiri Sora Park , Kansal Kari Joanne , Gin Greg E , Zell Jason A. , Bristow Robert E. 
Published: May 2020

7031 Background: There are a limited number of studies that have evaluated the association between National Comprehensive Cancer Network (NCCN) guideline adherence and survival across different cancers. We aim to assess the relationship between race/ethnicity, socioeconomic status (SES), insurance type and the receipt of NCCN guideline concordant cancer care and survival. Methods: This is a retrospective population-based cohort study of patients with 7 types of invasive cancer using the California Cancer Registry. Adherence with NCCN guidelines was defined by appropriate surgical, radiation, and chemo- or hormonal therapies. Multivariate logistic regression was used to evaluate the relationship between the patient, insurance type, tumor, and guideline adherence. Disease-specific survival analysis was performed using multivariate proportional hazards model. Results: A total of 543,198 patients were identified with invasive cancer between 2004-2017 (cases by disease type: breast 189,311, prostate 156,502, colon 80,102, liver 25,857, gastric 22,066, ovary 22,551, and cervix 16,691). The proportion of patients receiving NCCN guideline-concordant care varied by disease type. Non-concordant guideline treatment was associated with increased disease-specific mortality across all cancer types: breast (HR 1.28, 95%CI 1.23-1.33), prostate (HR 1.31, 95%CI 1.22-1.41), colon (HR 1.73, 95%CI 1.67-1.78), liver (HR 2.52, 95%CI 2.42-2.63), gastric (HR 2.38, 2.28-2.49), ovary (HR 1.32, 95%CI 1.26-1.38), and cervical cancer (HR 1.17, 95%CI 1.08-1.26). In multivariate models, compared to White, black patients were less likely to receive guideline concordant care for breast (OR 0.88, 95%CI 0.84-0.92), prostate (OR 0.90, 95%CI 0.86-0.93), colon (OR 0.85, 95%CI 0.79-0.92), and ovarian cancer (OR 0.71, 95%CI 0.62-0.82). Compared to Managed care insurance patients, Medicaid payer status was also associated with lower guideline concordant care for breast (OR 0.81, 95%CI 0.78-0.84), prostate (OR 0.91, 95%CI 0.86-0.97), colon (OR 0.70, 95%CI 0.65-0.75), gastric (OR 0.69, 95%CI 0.63-0.75), and liver cancer (OR 0.66, 95%CI 0.61-0.72). Conclusions: Less than half of cancer patients received NCCN guideline concordant care. There was an incremental relationship observed between SES and the likelihood of receiving guideline concordant care. Patients receiving non-guideline concordant care had worse disease-specific survival.