bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a stop light tool using the bellarmine norton assessment tool (BNAT) for physical therapy referral.
Authors: Crandell Catherine Elizabeth , Wingard Christopher Jon , Quinn Sarah Elizabeth , Amin Kate Elise , Brownschidle Katie Marie , Dahm Donna , Huebler Lauren , Mayo Kelsey Lynn , Hamm John Turner 
Published: May 2020

e19067 Background: Individuals with cancer experience fatigue, pain and decline in function. The Bellarmine Norton Assessment Tool (BNAT) was developed to give an objective measure identifying a person’s overall functional ability through a variety of physical assessments focused on mobility and strength. The purpose of this study was to develop a referral tool to provide health care professionals an easy determinant for physical therapy referrals. The referral tool was designed as a Red, Yellow, Green light for easy interpretation and use. Methods: The BNAT is composed of 1 self-reported physical activity question and 4 objective tests: 2-Minute Step Test (2MST); 30-Second Sit-to-Stand; Timed Arm Curl; and Timed Up and Go. A previously collected data set of BNAT scores was utilized to develop the referral tool with the poorest performance corresponding to Red and the best corresponding to Green. Three variations of normative scaling examined optimal distribution for classification. The first model averaged normative data of 70-74 age group of healthy individuals. No participants in our study achieved 50% of population norms. Therefore, the Green light represented 35% of the normative values, the Yellow light ranged from 15-34% and the Red light identified < 15%. A second model used frequency histograms for each BNAT elements. Groupings were made based on the natural break of the data to depict the Red, Yellow or Green light. A third approach combined normative and frequency distribution for each element as compared to the respective BNAT scores. The outcome assigned BNAT score of 1 and 2 to Red light, 3 to Yellow light and 4 and 5 to Green light. Except for the 2MST, these models were similar for the cutoff between color categories. The third model best fit the study population with respect to the individual’s total BNAT score. Results: Of the 161 subjects, 47 subjects (29%) fell into the Red category, 81 (50%) into Yellow and 33 (21%) into Green. Using this scaling system for the total BNAT score, 13 score combinations result in Red light, 6 scores for Yellow light and 6 scores for Green light. Regardless of the model, most individuals were assigned a Yellow light. Conclusions: The literature is void of functional cut off scores and normative distributive data for the oncology population. We defined a referral tool with scaling based off normative scores and functional assessments that reflect the distribution of oncology patients. The third model may be used as a simple referral tool among multiple health care professionals aiding in a referral for physical therapy.
Assessing social determinants of health in a safety-net oncology population: Use of an EHR-based screening and referral system.
Authors: Tsai Rebecca N. W. , Qureshi Muhammad M. , Losi Stephanie , Dyer Michael A. , Truong Minh Tam , Buitron de la Vega Pablo , Mak Kimberley S. 
Published: May 2020

e19072 Background: Routine electronic health record (EHR)-based screening and resource referral to address social determinants of health (SDOH) have been established in adult primary care clinics and the emergency department of New England’s largest safety-net hospital. The burden of SDOH in safety-net oncology patients is less well-studied. This study aimed to understand the social needs of this vulnerable patient population and evaluate the need for implementation of SDOH screening in the oncology clinic. Methods: Patients with lung or head and neck cancer seen in consultation in the Department of Radiation Oncology at Boston Medical Center between 3/2019-1/2020 were identified. EHRs were reviewed for receipt of THRIVE, an EHR-based screening and referral model addressing SDOH. Associations between patient demographics and SDOH screening were evaluated. Results: A total of 104 head and neck (n = 53; 51%) and lung (n = 51; 49%) patients were identified. Median age was 65 years (interquartile range 57.5-72). The majority of patients were male (71.2%), and English-speaking (82%). Whites, Blacks, and Asians comprised 43%, 38%, and 3% of patients, respectively. Fifteen patients were Hispanic (14%). Patients were most likely to have private health insurance (n = 41; 39%), followed by joint Medicare-Medicaid plans including senior and community health plans for elderly (n = 27; 26%), Medicaid (n = 17; 16%), and Medicare (n = 17; 16%). 83 of 104 patients (79.8%) were screened for at least one SDOH domain, with 55 patients (66%) screened before presentation in radiation oncology clinic. Transportation to medical appointments (16%), food insecurity (14%), and inability affording medications (10%) were the most prevalent concerns among these oncology patients. Housing insecurity, utilities, caregiving, unemployment, and education were identified social concerns for 4-5% of patients. The majority of patients who had at least one social need requested resources to assist them (71%). Age, gender, race, language, and insurance status were not associated with receipt of the SDOH screener (p≥0.1). Conclusions: Safety-net oncology patients report significant social needs. Routine SDOH screening and resource referral should be considered in these vulnerable patients.
A knowledge, attitudes and practices survey for medical trainees about cancer in the LGBTQ community.
Authors: Taneja Alankrita , Stark Sabrina , Chokshi Bhavin , Alhusain Rashid 
Published: May 2020

e19073 Background: The purpose of our study was to assess the extent of knowledge, attitudes and practices regarding cancer in the LGBTQ community among medical students and resident physicians at the Detroit Medical Centre/Wayne State University program. Methods: A 15 question validated survey was electronically provided to medical students and resident physicians. The survey included questions that assessed the knowledge, attitudes and practices regarding cancer in the LGBTQ community. Respondents selected a choice based on a 5 item rating scale that ranged from "strongly agree" to "strongly disagree." In addition, participant demographics including training level and gender/sexual identity were collected. Descriptive statistics (counts and percentages) were used to quantify survey responses. Results: A total of 110 responses were received. The respondents consisted of 77% medical students as well as 8.2% interns and 13.7% senior residents in the department of internal medicine. Five percent of the responders reported having rotations in Corktown Health Center, which is an LGBTQ clinic. Majority (82.7%) reported that they were heterosexual while the rest were homosexual, bisexual, pansexual or preferred not to say. In terms of knowledge, one third of the responders reported being well informed on the health needs of LGBTQ patients. While majority (82.1%) believed that LGBTQ patients avoid accessing healthcare, 7% of the respondents disagreed that transgender individuals are less likely to have health insurance. In terms of attitudes, majority (97%) agreed that the LGBTQ population has unique health risks. 82% of the responders believe that it is important to know the gender identity and the sexual orientation of the patients to provide the best care, however only 30% practiced actively inquiring about a patient’s sexual orientation when taking a history. One third of the responders assume that the patient is heterosexual upon first encounter. Ninety five percent of medical trainees agreed that formal education needs to be provided in medical school or as part of residency curriculum on LGBTQ health needs. Conclusions: Our survey shows that there is a gap in knowledge and practices of medical trainees about health needs of the LGBTQ population. Majority of the respondents believe that training about cancer in the LGBTQ population needs to be integrated into medical school or residency curriculum. Exclusion of LGBTQ- specific health needs from medical school and residency curricula contributes to cancer related health inequities faced by this population.
Disparities in use of immunotherapy for stage III and IV melanoma patients.
Authors: White Richard L. , Trufan Sally Jeanne , Gower Nicole Lee , Neelands Brittany , Amin Asim 
Published: May 2020

e19087 Background: Approval of immune checkpoint inhibitors (ICIs), ipilimumab (ipi), nivolumab and pembrolizumab has significantly changed the outcome for patients with stage III and IV melanoma. Adoption of ICI based immunotherapy (IT) and utilization has not been studied. We sought to assess the utilization of ICI therapy and identify barriers that limit access. Methods: The National Cancer Database (2004-2016) was used to analyze stage III and IV melanoma patients separately using descriptive statistics, univariable and multivariable models to compare use of IT (yes/no) with sex, race, age, Charlson-Deyo score, insurance status, census median income, census education, distance to treating facility, year of diagnosis and facility type. Results: Of 15,373 stage III patients 2,555 (16.6%) received IT. Since approval of ipi for resected stage III disease, 20.8% received adjuvant treatment in 2015 and 28.2% in 2016 (Table). Multivariable analysis showed that older patients (OR 0.96 (0.96-0.97)), those treated at non-academic programs (community cancer (CC) (OR 0.69 (0.55-0.86)), comprehensive CC (OR 0.55 (0.49-0.70)), or integrated network cancer program (INCP) (OR 0.58 (0.49-0.70))), have government insurance (OR 0.80 (0.70-0.90)) or no insurance (OR 0.78 (0.64-0.94)) vs private insurance were significantly less likely to receive adjuvant IT. Of 21,718 stage IV patients, 3,098 (14.3%) received IT. Using multivariable analysis, patients with fewer co-morbidities (OR 1.4 (1.05-1.86)) diagnosed in 2011 or later (Table) were more likely to receive IT. Disparities were noted in older patients (OR 0.98 (0.97-0.98)), those treated at non-academic programs (CC program, OR 0.34 (0.28-0.41)), comprehensive CC program (OR 0.34 (0.30-0.38)), or INCP (OR 0.40 (0.34-0.46)), and low vs high education level (OR 0.75 (0.62-0.90)) as less likely to receive IT. Conclusions: Despite approval and significant impact of ICIs, many patients did not receive approved therapy. Variations in care depended on where patients received treatment, age, and education level. [Table: see text]
Clinicopathologic and molecular genetic comparison of primary uterine serous adenocarcinomas from African American and Caucasian women.
Authors: Wang Aifen , Chen Youguo , Holloway Robert W. , Pei Zhe , Yang Jinsong , Zhao Yingyan 
Published: May 2020

e19092 Background: The study aimed to identify whether there were racial disparities in the clinicopathologic features and genetic mutation characteristics between African American (AA) and Caucasian women with uterine serous carcinoma. Methods: Clinicopathologic features, molecular genetic data of patients with uterine serous carcinoma were obtained from The Cancer Genome Atlas (TCGA), including age of diagnosis, body mass index (BMI), tumor grade, FIGO stage, myometrial invasion, lymph node involvement, overall survival and progression free survival. MLH1, MSH2, MSH6, PMS2, BRCA1, BRCA2, CHEK2, TP53 mutations were involved. A statistical analysis of these parameters was performed for AA and Caucasian women. Results: 44 AA and 97 Caucasian patients with uterine serous carcinoma were analyzed. There were no PMS2 and BRCA2mutations in tumors of African American patients. Compared to Caucasian patients, tumors from AA patients had no statistically significant differences in Lynch syndrome related genes ( MSH2, MSH6, PMS2) (4.5% versus 14.3%, p = 0.149) and HR pathway genes ( BRCA1, BRCA2, CHEK2) (9.1% versus 19.6%, p = 0.09). Tumors from AA patients had no statistically significant differences in alterations of the TP53 gene (79.5% versus 71.3%, p = 0.312). There were no statistically significant differences between the two groups regarding age at diagnosis, BMI, tumor histology, tumor grade, lymph node involvement, myometrial invasion, FIGO stage, overall survival or progression-free survival between the two groups ( p > 0.05). Conclusions: This study identified no statistically significant differences in clinicopathologic features and genetic mutations in AA and Caucasian women with uterine serous carcinomas. Especially, there were no differences in survival identified between two groups. Much larger database may be necessary to be analyzed in future. [Table: see text]
Nationwide analysis of healthcare burden and risk of mortality in cancer patients with deep venous thrombosis.
Authors: Ba Aqeel Sheeba Habeeb , Lingamaneni Prasanth , Farooq Muhammad Zain , Baral Binav , Banskota Shristi Upadhyay , Gupta Shweta 
Published: May 2020

e19093 Background: Occurrence of venous thromboembolism is well known to have increased mortality in cancer patients with pulmonary embolism known to be the leading contributor. However, risk of mortality and healthcare burden with deep venous thrombosis (DVT) alone is not well elucidated, and primary prophylaxis is still controversial. We sought to evaluate risk of hospitalization, mortality, as well as, differences in resource utilization in patients with and without cancer, who were diagnosed in the emergency department (ED) with acute DVT alone. Methods: Adult patients diagnosed with acute DVT from January 2016 to December 2017 were identified from the Nationwide Emergency Department Samples (NEDS) database. Univariate and Multivariate logistic regression analysis was used to compare the risk of admission from the ED and inpatient mortality in DVT patients with cancer and those without. Secondary outcomes assessed were length of hospital stay (LOS), inpatient hospital charges, risk of GI bleed, and rates of inferior vena cava (IVC) filter placement and thrombolysis. Results: A total of 404,121 patients were diagnosed with acute DVT only, of which 8% had an underlying malignancy. Most common primary cancers were GI tract (20.1%), hematologic (16.5%) and lung (13.5%). Patients with cancer were older (mean age 66.4 vs 59.8 years, p<0.0001), with a slight male preponderance (51.8% vs 47.5%, p<0.0001). They were also more likely to be admitted from the ED (70.5% vs 39.1%, p<0.0001). Patients with malignancy had longer length of stay, higher hospital charges, higher mortality and rates of GI bleed (p<0.001 for all outcomes). On multivariable analysis, after adjusting for age, sex and comorbidities, patients with cancer were more likely to be admitted than those without cancer (OR 3.71, CI 3.41-4.04, p<0.001), had higher mortality (OR 3.09, CI 2.42-3.94, p<0.001) and rates of GI bleed (1.75, CI 1.45-2.12, p<0.001). Likely for this reason, patients with cancer were more likely to undergo IVC filter placement (15.2% vs 9.4%, p<0.0001) and less likely to receive thrombolysis (4.5% vs 7.4%, p<0.0001). Conclusions: Cancer patients with DVT presenting to ED had higher hospitalization rates with increased risk of mortality, GI bleed, IVC filter placement and decreased rates of thrombolysis than those without malignancy that was compounded by longer in-hospital LOS and healthcare costs. Further studies are needed to evaluate the need of prevention strategies for DVT that can help mitigate these factors in cancer patients.
The impact of therapeutic mediastinal radiation on stent healing in cancer patients: An optical coherence tomography study.
Authors: Graham Jordan , Aziz Moez , Donisan Teodora , Balanescu Dinu Valentin , Palaskas Nicolas , Lopez-Mattei Juan , Cilingiroglu Mehmet , Balanescu Serban Mihai , Ganim Nidal M , Lin Heather Y. , Marmagkiolis Konstantinos , Molony Donald A. , Durand Jean-Bernard , Iliescu Cezar 
Published: May 2020

e19096 Background: Cancer is a prothrombotic and proinflammatory state. Understanding stent healing in cancer patients could modify the approach to antiplatelet regimen and facilitate cancer treatment. Mediastinal radiation therapy brings an additional layer of complexity to an already challenging clinical scenario in cancer patients undergoing percutaneous coronary intervention (PCI). We sought to compare stent healing patterns with and without a history of mediastinal radiation therapy using optical coherence tomography (OCT) data. Methods: All cancer patients that underwent PCI and follow-up OCT less than 12 months post-PCI between 2009-2018 were retrospectively identified from our institutional cardiac catheterization laboratory registry. Stent healing, which was defined by a combination of stent and strut coverage, apposition, expansion, in-stent restenosis, and neo-intimal hyperplasia, was compared among 2 groups of oncological PCI patients: those with and without a history of mediastinal radiation therapy. Differences among the two categories were assessed using linear-effect models. Results: There were 86 cancer patients who received PCI with follow-up OCT within 12 months. Of these, 22% received mediastinal radiation. There was no statistical difference in baseline characteristics (hypertension, dyslipidemia, diabetes, etc.) between the two studied groups. In the non-radiation group, 59% were late stage or advanced cancer patients, while 63% of patients in the radiation group were advanced cancer patients. Stent healing was similar among those who had received radiation therapy and those who had not (Table). Conclusions: A history of mediastinal radiation does not appear to affect early stent healing within 1 year of PCI. Given stent healing appears to be similar with or without radiation, dual anti-platelet therapy regimens may not need to change based on radiation exposure alone. Future studies should address the duration of dual antiplatelet regimens and long-term outcomes (i.e. in-stent restenosis) based on stent healing properties. [Table: see text]
Retrospective study of the evaluation and management of febrile neutropenia in cancer patients in a tertiary center.
Authors: Emmich Megan , Bhardwaj Prarthna V , Clark Jackson , Sridhar Arthi , Ali Fatima , Walia Ritika , Knee Alexander , Lagu Tara , Loh Kah Poh 
Published: May 2020

e19100 Background: Febrile neutropenia is a medical emergency often managed by internists, but adherence to guidelines has not been well-described. We aimed to describe care and outcomes of a retrospective cohort of patients hospitalized with febrile neutropenia at a single tertiary care hospital. Methods: We included adults ≥18 years old who had a cancer diagnosis and required hospital admission for a principal diagnosis of fever and neutropenia (ANC < 500) from October 2015 - April 2019. We reviewed records to identify demographics, cancer diagnosis and stage, and outcomes, including death. Results: We included 193 patients; all were cared for by hospitalists. About half (52%) were classified as high risk [ < 21 Multinational Association of Supportive Care in Cancer (MASCC)score], but only 1 patient had a documented MASCC score in hospital progress notes. The majority of patients were female (55%) and white (84%). Twenty-three percent had a stage IV diagnosis. Most (89.1%) patients were within their first chemotherapy cycle, and 23% received GCSF. Approximately half (47%) had solid tumors; the remainder had hematologic malignancies. About one quarter (27%) had positive blood cultures (of these, 43.4 % were gram positive cocci (GPC); 49.1% were gram negative rods (GNR)). Most patients received empiric coverage for GPC and GNR: 82% received cefepime and 42% received empiric MRSA coverage. Few patients had cultures positive for resistant organisms such as MRSA (n = 3) or pseudomonas (n = 4). Hematology/Oncology was consulted for most (82%) cases. Inpatient mortality occurred in 12% of patients. Compared to those who survived, patients who died had lower MASCC score 13.9 (vs. 19.1) and were more likely to receive critical care therapies during hospitalization (70% vs. 14%). Few patients (n = 24, 12%) had documented goals of care (GOC) discussions. Conclusions: Although MASCC is predictive of outcomes, internists caring for patients with fever and neutropenia do not document this score. Hospitalist-focused education efforts about MASCC score could improve care. Few patients had documented GOC discussions. Oncologists should maintain good communication with internal medicine colleagues, who may be hesitant to address GOC in patients receiving chemotherapy.
Marital status and suicide as a competing cause of mortality among cancer survivors.
Authors: Osazuwa-Peters Nosayaba , Simpson Matthew C , Du Eric Y , Hong Scott A , Bukatko Aleksandr R , Adjei Boakye Eric , Varvares Mark A 
Published: May 2020

e19113 Background: The risk of suicide among cancer survivors more than double that of the general population, highlighting the need to mitigating risk factors for suicide. While several studies have described marital status, a surrogate for social support, as associated with cancer mortality, it is inconclusive whether marital status impacts suicide as a competing cause of cancer mortality. We tested this hypothesis by describing the association of marital status and suicide among survivors of four cancer sites with the highest suicide mortality rates in the United States. Methods: Adult cancer patients were identified from the Surveillance, Epidemiology and End Results database from 2004 to 2016 for four index cancer sites previously identified with highest suicide mortality rates: pancreas, head and neck, lung/bronchus and stomach ( n = 800,798). Cumulative incidence curves stratified by marital status (divorced/separated, widowed, never unmarried, and married/partnered) estimated unadjusted probability of suicide (outcome of interest). A multivariable competing risk proportional hazards model yielded sub-distribution hazard ratios (sdHRs) and 95% confidence intervals (CI) to estimate the association of marital status with suicide for each cancer site, while controlling for clinical and nonclinical factors. Results: Half (50.7%) of the cohort were married/partnered, males (56.8%), and non-Hispanic whites (71.0%). Mean age at diagnosis was 67.3 years. Most patients (60.9%) had cancer in the lung/bronchus, 17.9% head and neck, 13.8% pancreas, and 8.3% stomach. Unadjusted probability of suicide was highest among head and neck cancer survivors (0.3%). In the fully adjusted model, mortality by suicide was more likely among divorced/separated patients vs. married/partnered patients across cancer sites (sdHRhead and neck = 1.81; 95% CI 1.38, 2.37; sdHRlung/bronchus = 1.68; 95% CI 1.28, 2.19; sdHRpancreas = 2.19; 95% CI 1.27, 3.78; and sdHRstomach = 2.38; 95% CI 1.17, 4.58). Additionally, for lung/bronchus cancer, patients who were never married patients were more likely to die by suicide than those married/partnered (sdHRlung/bronchus = 1.47; 95% CI 1.09, 1.98). Conclusions: Marital status is associated with suicide mortality among cancer survivors, and divorced/separated survivors may have greater suicide mortality risks, independent of cancer site. As overall probability of suicide remains low, these findings might help identify cancer survivors who may be candidates for ongoing surveillance and psychosocial support to mitigate suicide mortality risks.