bluuebunny/crossref_metadata_2025_split huggingface dataset:
Racial differences in delay of treatment for localized prostate cancer (CaP): A population-based study.
Authors: Stokes William Allen , Hendrix Laura H , Royce Trevor Joseph , Allen Ian M. , Wang Andrew , Chen Ronald C. 
Published: March 2020

6037 Background: African-Americans (AA) are diagnosed with more advanced CaP than Caucasians (CA) and are more likely to die from CaP. Treatment delay is a potentially modifiable obstacle to care and clinically may be more important in AA patients because of more aggressive cancer at diagnosis. We examined time from diagnosis to curative treatment (surgery or radiation) in AA and CA patients in the Surveillance, Epidemiologic and End Results (SEER)-Medicare linked database. Methods: 21,454 CA and 2,506 AA patients who were diagnosed with non-metastatic CaP from 2004-08 and received treatment within 12 months of diagnosis were included. Linear regression was used to examine factors associated with number of days from diagnosis to treatment initiation, and logistic regression to assess odds of treatment within 6 months of diagnosis. Results: AA patients were more likely to have high-risk CaP than CA patients (39 vs. 35%), and less likely to have low-risk CaP (27 vs. 31%) (p<.001). Time to treatment was significantly prolonged for AA patients in all risk groups of CaP, and the difference was most prominent for high-risk patients (median 105 days for AA vs. 96 days for CA, p=.002). Racial differences in time to treatment persisted in multivariable analysis (Table). Sensitivity analyses examining the proportion of AA and CA patients initiating treatment within 6 months of diagnosis revealed similar results. Conclusions: AA patients, especially those with high-risk CaP, experience longer treatment delays than CA patients. This is the first large-scale study to examine treatment delays in AA and CA patients with CaP. The differences found may contribute to our understanding of racial disparities in CaP treatment outcomes. [Table: see text]
Utilization of accelerated partial breast irradiation for ductal carcinoma in situ, 2002-2007: Report from the National Cancer Data Base.
Authors: Czechura Tomasz , Yao Katharine , Huo Dezheng , Shaikh Arif , Winchester David Porter , Winchester David J. 
Published: March 2020

6040 Background: The use of accelerated partial breast irradiation using brachytherapy (APBI-b) for patients with invasive cancer is increasing but data for ductal carcinoma in situ (DCIS) cases are limited. The American Society of Radiation Oncology (ASTRO) guidelines suggest that APBI-b should be used only on a "cautionary" or "on trial" basis for women with DCIS. The purpose of this study was to examine utilization trends and correlates of APBI-b use for patients with DCIS. Methods: A total of 70,043 postlumpectomy patients from the National Cancer Database diagnosed with DCIS between 2002 and 2007 were studied. Chi-square tests and logistic regression models were used to determine trends and factors related to APBI-b use. Results: The use of APBI-b increased from 0.7% in 2002 to 10.0% in 2007 (p<0.001). Independent predictors APBI-b use were age, race, insurance status, comorbidity index, facility type, and facility location. Older patients were more likely to use APBI-b; relative to patients 30-39 years old, the OR for patients 80-89 years old was 5.9 (95% CI: 3.7-9.6). APBI-b use was higher in whites (4.9%), compared to blacks (4.4%), Hispanics (2.8%), and Asian pacific islanders (1.5%; p<0.001). Compared to noninsured, Medicare (OR=2.1, 95% CI: 1.3-3.3) and managed care patients (OR=2.0, 95% CI: 1.3-3.2) were more likely to undergo APBI-b. 2.3% of community cancer programs, 5.7% of comprehensive community programs and 4.1% of academic/research programs utilized APBI-b for treating DCIS (p<0.001). The use of APBI-b varied significantly by facility location; the West and South regions of the country were more likely to use APBI-b (OR=14, 95% CI: 10.1-19.6) than the Northeast region. 91% of the APBI-b patients fit the ASTRO "cautionary" guideline and 9% of patients fit the ASTRO "on trial" guidelines. In 2002, 4% of ABPI-b patients fit the "on trial" guidelines which increased to 8.6% in 2007 (p<0.001). Conclusions: The use of APBI-b for DCIS increased from 2002-2007. APBI-b use varies by socioeconomic and facility factors with age being the most significant factor. Future studies are needed to determine the indications for APBI-b in patients with DCIS.
Prospective evaluation of perceived barriers to medication adherence by patients on oral antineoplastics.
Authors: Muluneh Benyam , Alexander Maurice , Deal Allison Mary , Deal Meredith , Markey Janell , Neal Jennifer , Bernard Stephen A. , Valgus John , Dressler Lynn G. 
Published: March 2020

6042 Background: Appropriate use of oral antineoplastics (OA), especially those with a food-effect, is a challenge for patients and clinicians. Patient adherence is essential to optimize outcomes, minimize toxicity, minimize bias in clinical trials, and reduce health care costs. As the use of OA grows, due to the narrow therapeutic margin, it is critical to understand the barriers to patient adherence. The purpose of this study was to analyze cancer patients’ use of OAs and identify opportunities to improve patient adherence. Methods: We developed and tested a 30-question survey to address frequency and reasons for reducing/skipping doses; sources of information for OA use; perceived importance of food-drug effects, and ease of understanding directions on vial label. Surveys, consisting of Likert scale and multiple choice questions, were distributed to adult cancer patients on OAs at the UNC Cancer Hospital clinics. Results: Seventy-seven patients taking OAs with CML, RCC, breast cancer, and GI tumors completed the survey with a response rate of 97%. This was a well-educated population with 71% having completed some college; 54% female and 58% older than 50 years. Forty-three percent of patients taking drugs with a significant food-drug effect (sorafenib, pazopanib, lapatinib, imatinib, nilotinib, and capecitabine) did not think about the last time they ate before taking their OA and 23% did not know that their OA had a food-drug effect. In addition, 21% of patients indicated they intentionally skipped/cut back on their OAs and 38% of those did not inform their physician. Although 97% reported no difficulty reading instructions on drug vial, nearly 20% had some difficulty understanding the directions. Conclusions: There are three main barriers associated with appropriate use of OAs: confusion or misunderstanding about the timing of drug with food; reducing/stopping drug without informing MD; and difficulty understanding directions on the drug vial label. A multipronged integrated approach involving the pharmacist, physician and nurse is needed to optimize communication of directions for optimal OA use.
Osteoporosis screening among prostate cancer survivors treated with androgen deprivation therapy.
Authors: Morgans Alicia Katherine , Smith Matthew Raymond , O'Malley A. James , Keating Nancy Lynn 
Published: March 2020

6045 Background: Androgen deprivation therapy (ADT), the standard systemic treatment for prostate cancer, has adverse effects including bone loss and fractures. Current national guidelines suggest that men receiving ADT undergo dual energy x-ray absorptiometry (DXA) before and during ADT to better characterize fracture risk. We assessed receipt of DXA testing in a population-based cohort of men treated continuously with ADT for at least 1 year and identified factors associated with testing. Methods: Using Surveillance, Epidemiology, and End Results-Medicare data, we identified men aged >65 with local or regional prostate cancer diagnosed during 2001-2007 and followed through 2009 who received at least 1 year of continuous ADT. We identified receipt of DXA testing in the 18-month period beginning 6 months before the first dose of ADT. We used logistic regression to identify factors associated with DXA testing, including patient and tumor characteristics and the physicians with whom they had outpatient visits. Results: Among 28,960 men treated with ADT for ≥1 year, 6.5% had at least one DXA scan from 6 months before the first dose of ADT through 1 year after. DXA testing increased over time, with men initiating ADT in 2007-2009 more likely to be tested than those treated in 2001-2002 (10.0% vs. 3.4%, OR 2.29, 95% CI 1.83-2.85). Men aged ≥85 were less likely than men aged 66-69 to undergo testing (OR 0.76, 95% CI 0.65-0.89). Black men were less likely than white men to undergo testing (OR 0.92, 95% CI 0.61-0.86), as were men living in areas with lower educational attainment (P<.001). Compared with men seeing a urologist but no medical oncologist or primary care provider (PCP), men seeing a medical oncologist and a urologist (OR 2.11, 95% CI 1.39-3.21) and those seeing a medical oncologist, urologist and PCP (OR 2.59, 95% CI 2.01-3.34) had higher odds of testing. Conclusions: Few men receiving ADT for prostate cancer undergo DXA testing, with particularly low rates of testing among older men, black men, and those living in areas with low educational attainment. Visits with a medical oncologist were associated with increased odds of testing. Interventions are needed to increase bone density testing among men receiving long-term ADT.
Disparities in preoperative imaging for breast cancer: Not so black and white.
Authors: Bleicher Richard J. , Ruth Karen , Sigurdson Elin R. , Evers Kathryn , Crivello Margaret Lord , Wong Yu-Ning , Boraas Marcia , Egleston Brian 
Published: March 2020

6061 Background: Controversy exists about racial/ethnic differences in the care of breast cancer patients. Imaging plays a critical role in evaluation, but little national data exists on breast imaging by race. This study was performed to determine if imaging disparities exist in Medicare patients, when adjusting for socioeconomic (SE) factors. Methods: Surveillance Epidemiology and End Results (SEER) data linked to Medicare claims were reviewed for patients diagnosed with invasive nonmetastatic breast cancer between 2000 and 2005, undergoing surgery as their 1st treatment modality. Diagnostic imaging was reviewed during the interval between the 1st physician visit and surgery (“preoperative interval”[POI]) and imaging use was defined as ≥1 imaging-specific claim. SE factors included rural/urban setting, and education, poverty, and median income per census tract. Results: Among 39,790 patients, there were 34,774 White (87%), 2,341 Black (5.9%), 1,459 Hispanic (3.7%), and 1,216 Asian/Pacific Islander (3.1%) patients. Univariate racial differences were noted for all imaging types (p’s <0.0001 to 0.007). During the POI, when adjusting for demographics, tumor characteristics, and SE factors in multivariable analysis, use of mammogram, ultrasound (US), breast MRI, CT, and bone scan were not different between Blacks and Whites. Education level was a predictor for US (p=0.007), breast MRI (p<0.0001), CT (p=0.006) and bone scan use (p=0.002), but not mammography (p=0.90). There were varying correlations between Hispanics or Asians vs Whites for all imaging types. Stage, histology, U.S. region, and comorbidity index were most consistently predictive of imaging use of all types. When evaluating 6 mos prior to the 1st physician visit along with the POI, 96.4% of all patients had ≥1 mammogram, with 94.1% of Blacks having mammograms vs 96.5% of Whites (OR 0.7, 95% CI 0.6-0.9; p=0.001). Conclusions: There is little racial difference in imaging performed during the POI for Medicare patients having breast cancer, and efforts to determine causes of survival disparities in such patients should be focused elsewhere. Whether these findings apply to the privately insured or the uninsured requires additional exploration.
Prevalence and characteristics of patients with stage IV solid tumors who receive no anticancer therapy.
Authors: Small Alexander C. , Tsao Che-Kai , Moshier Erin L. , Gartrell Benjamin Adam , Wisnivesky Juan P. , Godbold James H. , Smith Cardinale B. , Sonpavde Guru , Oh William K. , Galsky Matt D. 
Published: March 2020

6065 Background: Clinicians caring for patients with cancer are well aware that a subset of patients who present with metastatic solid tumors never receive anticancer therapy for reasons including poor functional status, comorbidities, and patient preference. The prevalence and characteristics of this population have not previously been described. Methods: The National Cancer Database was queried for patients diagnosed with metastatic (stage IV) solid tumors including breast, cervix, colon, kidney, small-cell and non-small cell lung [NSCLC and SCLC], prostate, rectum and uterus. Patients who received neither radiation therapy nor systemic therapy were identified. Other factors such as age, race, income, insurance status, and diagnosis year were assessed. In an exploratory analysis, log-binomial regression was used to estimate prevalence ratios (PR) for the proportion of untreated stage IV to treated stage IV cancer cases according to these factors. Results: From 2000-2008, 773,233 patients with stage IV cancer were identified of whom 159,284 (21%) received no anticancer therapy (Table). Patients with NSCLC accounted for 55% of untreated patients. Across all cancer types, older age (PR range 1.37-1.49, all p<0.001), black race (PR range 1.05-1.32, all p<0.001), lack of medical insurance (PR range 1.47-2.46, all p<0.001), and lower income (except uterus) (PR range 0.91-0.98 for every $10,000 income, all p<0.001) were associated with increased prevalence of not receiving treatment. Conclusions: Approximately 20% of patients who present with stage IV solid tumors never receive anticancer therapy. These findings have potential implications with regards to healthcare policy and access to care. [Table: see text]
Sown the seeds: An analysis of published trials in clinical oncology.
Authors: Spradlin Natalie M. , Johnson David H. , Horn Leora 
Published: March 2020

6068 Background: Competition in the pharmaceutical marketplace has resulted in “seeding trials” which appear to serve little scientific purpose other than to gain a financial hold in the marketplace. Hallmarks of “seeding” clinical trials [Kessler, et al N Eng J Med 1994] include trial design that does not support stated research goals, industry sponsorship without novel findings or poor scientific rationale, and drugs introduced into an already crowded therapeutic class, i.e. “me too” drugs. We evaluated clinical trials published in high impact oncology journals to ascertain the prevalence of trials bearing the characteristics of a seeding trial. Methods: We conducted a PubMed search using “clinical trial”, “oncology”, published 2/2005 – 2/2010, in Ann Oncol, J Clin Oncol, Lancet, Lancet Oncol, or the N Engl J Med. All phase I/II, II and III studies were included. Phase I, hematology, radiation oncology, and pediatric studies were excluded. Data collected included disease site, phase, funding source, journal, and whether the trial fit criteria for “seeding” as previously defined. Results: 1781 articles have been evaluated to date. 528 met criteria for analysis. 130 were considered seed studies. Seed studies per journal were Ann Oncol 26 of 128, J Clin Oncol 88 of 340, Lancet 8 of 22, Lancet Oncol 5 of 16, and N Engl J Med 3 of 22. Studies published per disease site and percent seed studies were melanoma 19 and 31.6%, breast 106 and 30.2%, GI 126 and 20.6%, lung 101 and 29.7%, GU 65 and 24.6%, gynecology 40 and 30%, head and neck 24 and 12.5%, CNS 24 and 12.5%, sarcoma 11 and 18.2%, and advanced cancer 12 with zero seeds. Overall phase totals were phase I/II 16, phase II 272, and phase III 240. Seed studies per phase were phase II 28.7%, phase III 21.7% and zero for phase I/II. 210 studies were solely industry sponsored, and of these, 37.1% were seed studies. Funding was not listed for 73 studies. Conclusions: The integrity of clinical trials is challenged in the race to claim major market share. Our analysis of clinical trials published in high impact oncology journals found seeding trials account for 24.6% of publications. 37.1% of industry sponsored trials are seed studies. Seed studies are more common among the major disease sites or sites for which targeted therapies exist.
Burnout prevalence in medical and radiation oncologists at British Columbia Cancer Agency (BCCA).
Authors: Fitzgerald Catherine A. , Le Lyly H. , Petrik David W. , Murphy Kevin C. 
Published: March 2020

6071 Background: Burnout, reported to affect 30-60% of oncology workers, is a syndrome of psychological distress typically manifesting in three dimensions: Emotional Exhaustion (EE), Depersonalization (DP) and Low Personal Accomplishment (PA). Causal factors include workload, dealing with terminally ill patients and difficulties maintaining a balance between professional and personal life. As workload rises due to increased complexity of therapy and increasing prevalence of cancer patients, burnout may increase, especially in times of financial constraint. We sought to determine the prevalence of burnout in medical and radiation oncologists working at BCCA, which provides all radiation and the majority of medical oncology services to BC’s 4.5 million people. Methods: In March 2011, BCCA oncologists were invited to participate in a confidential online survey consisting of basic demographics and the 22 item MasLach Burnout Inventory (MBI) instrument, the latter a validated tool measuring distress in the three main dimensions of burnout. Normative data for physicians were used to interpret the results. Results: Response rate was 59%, female:male 40:60% with similar response rates for medical and radiation oncology (60 v 59%). Of the 73 who indicated their age range, 34 (47%) were between 35 and 44 years old. Respondents indicated that they had considered reducing their Full Time Equivalent (FTE) (67%) or leaving BC (46%). In those with at least 2 scores at a severe level, these rates were 76% and 71% respectively. Conclusions: Over 60% of responding BCCA oncologists report burnout in at least one domain of the MBI tool. Many have considered leaving the province or reducing their hours. These data are consistent with Grunfeld’s survey of Ontario oncologists (CMAJ 2000), although the rate of burnout is higher in this survey. Further research into ways to lessen burnout in oncology is urgently needed. [Table: see text]
Deviations from guideline-based therapy for febrile neutropenia in cancer patients.
Authors: Wright Jason D. , Neugut Alfred I. , Lewin Sharyn Nan , Burke William M. , Lu Yu-Shiang , Herzog Thomas J. , Hershman Dawn L. 
Published: March 2020

6078 Background: Febrile neutropenia (FN) is a common cause of morbidity in cancer patients. We examined guideline and non-guideline based care for cancer patients hospitalized with FN and examined how treatment influenced outcomes. Methods: The Perspective database was used to examine the treatment of solid tumor patients with FN from 2000-2010. To capture initial decision-making, we examined treatment within 48 hrs of admission. Based on evidence-based guidelines we determined the appropriate use of guideline-based antibiotics as well as use of treatments not routinely recommended, vancomycin and granulocyte-colony stimulating factors (GCSF). Hierarchical mixed effects models were developed to examine the influence of patient, physician, and hospital characteristics on the quality of treatment. Patients were stratified into low and high-risk groups and the effect of initial treatment on outcome (nursing home discharge and death) examined. Results: Among 25,231 patients with FN, within 48 hours of admission blood cultures were obtained in 90%, guideline-based antibiotic administered to 79%, vancomycin to 37%, and GCSF to 63%. Patients treated at high-volume hospitals, by high-volume physicians and patients managed by hospitalists were more likely to receive guideline-based antibiotics (p<0.05). Vancomycin use increased with time from 17% in 2000 to 55% in 2010 while GCSF use only decreased from 73% to 55%. Patients treated by internists and hospitalists were more likely to receive vancomycin; high-volume physicians were less likely to treat with both vancomycin and GCSF (p<0.05). Among patients who received GCSF, 15% received only one dose and 22% received 2 doses of filgrastim. Among low-risk patients prompt initiation of guideline-based antibiotics decreased the risk of discharge to a nursing facility (OR=0.78; 95% CI, 0.66-0.91) and death (OR=0.65; 95% CI, 0.50-0.85). Conclusions: There is substantial variability in the initial treatment for FN in cancer patients. While use of appropriate empiric antibiotics is high, use of non guideline-based treatments such as vancomycin and GCSF are common. Physician and hospital factors are the most important predictors of both guideline and non guideline-based treatment.
Use and duration of chemotherapy (CT) in patients (pts) with metastatic breast cancer (MBC) according to tumor subtype (TS) and line of therapy (tx).
Authors: Seah Davinia Shien , Luis Ines Maria Vaz Duarte , Olson Erin Macrae , Sohl Jessica , Litsas Georgia , Winer Eric , Lin Nancy U. , Burstein Harold J. 
Published: March 2020

6089 Background: Benefits of CT vary widely in MBC pts. We aimed to describe the impact of breast cancer TS and line of tx on the duration of CT. Methods: In a retrospective analysis, we identified 205 pts treated with CT for MBC at the Dana-Farber Cancer Institute between 2005-8. TS were classified as hormone receptor (HR)+ (ER+/PR+/HER2-), triple negative (TN) (ER-/PR-/HER2-) or HER2+ (HER2+, any HR). CT duration was defined as "time from start of one CT line to the start of the next CT." Chi-square, Kruskal-Wallis, and Kaplan-Meier methods were used. Results: Median follow-up was 54 months (m). Most pts had received adjuvant tx, though 23% had MBC at diagnosis. Almost all HER2+ pts had concurrent anti-HER2 tx. CT duration was longest in 1st line with consecutive stepwise decrease. The proportion of pts who received CT beyond the 3rd line varied by TS: 52% of HER2+ pts received > 4 CT lines, compared with 37% of HR+ and 29% of TN pts. Duration in later CT lines also differed by TS. Median CT duration in HER2+ pts was > 4 m in all 6 lines, but HR+ and TN pts had a median CT duration of <4m from the 4th line onwards. Quartile estimates suggested a substantial fraction of HER2+ and HR+ pts receiving >6m of CT in 5th and 6th line; by contrast, CT duration for TN pts were consistently brief in later CT lines. Conclusions: TS determines the likely duration and number of lines of CT for MBC. Among HR+ and HER2+ pts who receive CT beyond 3rd line, there are substantial rates of prolonged tx suggesting clinical benefit. For TN pts, the opportunity for additional lines and the CT duration declined more dramatically. The true role of advanced (> 3rd) CT lines for all MBC in improving quality of life, survival, and the predictors of such benefit, warrant further study. [Table: see text]