bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes from a multidisciplinary thoracic oncology conference (MTOC) versus serial care (SC) in a community healthcare system.
Authors: Smeltzer Matthew , Ray Meredith , Faris Nicholas , Meadows Meghan , Fehnel Carrie , Akinbobola Olawale , Jackson Bianca M , Foust Courtney , McHugh Laura , Signore Raymond S. , Robbins Edward T. , Osarogiagbon Raymond U. 
Published: October 2020

55 Background: Lung cancer care delivery is complex, with disparate quality and outcomes. Prospective multidisciplinary case planning is a recommended but poorly validated solution. We conducted a prospective comparative effectiveness trial to evaluate the impact of multidisciplinary care on care processes and long-term survival in a large community-based healthcare system. Methods: We previously reported primary objective results comparing patients in the multidisciplinary clinic (MDC) with those not cared for in the MDC i.e. usual, SC. However, a subset of the SC subjects (and all MDC subjects) were discussed at a weekly MTOC. In this secondary analysis, we compare all subjects who were prospectively discussed at MTOC (with or without MDC) with ‘true’ SC (TSC). Subjects were frequency matched by age range, race, insurance, performance status, and initial clinical stage. We compared the thoroughness of staging, use of guideline-concordant treatment, and survival. Models were stratified by frequency matched variables and adjusted for age, sex, and histology as covariates. Statistical methods included chi-square, logistic regression with adjusted Odds Ratios (aOR), and Proportional Hazards models with adjusted Hazard Ratios (aHR); both with 95% confidence intervals. Results: Of 526 subjects enrolled, 246 (47%) were discussed at MTOC. MTOC patients were older (median age 68 v 66, p = 0.03), less intense smokers (p = 0.03), and more commercially insured (p = 0.02). Fewer MTOC subjects were clinical stage IV (33% v 45%, p = 0.01). The MTOC patients had significantly greater odds of bimodal staging (aOR: 2.2 [1.3, 3.8]), trimodal staging (2.6 [1.8, 3.8]), invasive stage confirmation (2.6 [1.7, 3.9]), and mediastinal stage confirmation (2.4 [1.6, 3.6]; all p < 0.01). The additional stage confirmation resulted in more patients who were up- or down-staged in MTOC (44% v 33%, p = 0.03). MTOC patients were twice as likely to receive National Comprehensive Cancer Network guideline-concordant treatment (aOR: 2.0 [1.3, 3.2]). Despite more thorough care, time from initial lesion detection to treatment was similar (mean: 2.86 vs. 2.83 months, p = 0.71). Health-related quality of life measures did not differ between the two arms (P = 0.07 to 0.99). We found no difference in overall (aHR: 1.1 [0.9, 1.4]) or disease free survival (aHR: 1.1 [0.9, 1.3]) between MTOC and TSC. Conclusions: MTOC improved the thoroughness of care and delivery of appropriate treatment, without delays in treatment initiation or survival improvement.
Ovarian cancer patients’ perspectives on facilitators and barriers to accessing financial assistance.
Authors: Liang Margaret Irene , Simons Janice Leahgrace , Herbey Ivan I. , Wall Jaclyn , Rucker Lindsay , Ivankova Nataliya V. , Pisu Maria , Huh Warner King 
Published: October 2020

64 Background: Our aim was to obtain ovarian cancer patients’ perspective on accessing financial assistance programs. Methods: We recruited ovarian cancer patients receiving systemic therapy who screened positive for financial distress using Comprehensive Score for Financial Toxicity <26. Two interviewers conducted 45-minute interviews on the costs of care, which were recorded and transcribed. Three coders used inductive thematic analysis to identify themes. Results: There were 18 of 22 interviews currently evaluable. Median age was 57 and 68% of participants reported income <$40,000. Facilitators and barriers to accessing financial assistance are shown in the table below. Conclusions: Patients’ reliance on existing support systems and cancer organizations highlight a need for health systems to leverage these relationships and improve organized efforts to provide information related to financial assistance. Proactively asking about financial needs and providing resources to all patients, regardless of income, may mitigate patient reported barriers to accessing financial assistance. [Table: see text]
Adolescent and young adult cancer patients' health insurance experiences, expectations, and literacy.
Authors: Waters Austin R. , Mann Karely , Warner Echo L. , Vaca Lopez Perla L. , Kaddas Heydon K. , Ray Nicole , Tsukamoto Tomoko , Fair Douglas Beaty , Lewis Mark Andrew , Perez Giselle K. , Park Elyse R. , Kirchhoff Anne C. 
Published: October 2020

65 Background: Adolescent and young adult (AYA) cancer patients (15-39 years of age) often report health insurance concerns and financial toxicity due to their life-saving treatment. AYAs often have limited experience with healthcare prior to their diagnosis, which may limit their understanding of health insurance concepts, coverage, and costs. To describe AYA health insurance experiences, expectations, and literacy, we conducted semi-structured interviews with AYA cancer patients and survivors. Methods: Eligible participants were 18-39 years, diagnosed with cancer, and insured. Participants were recruited through an AYA cancer navigation program in Utah from 10/2019-03/2020. Participants were purposively sampled to achieve equal age strata (18-25 vs. 26-39), as patients under 26 often remain on their parents policy. Individual interviews were recorded, transcribed, and analyzed. Inductive qualitative analysis was conducted to describe their experiences with and understanding of their insurance. We calculated descriptive statistics of demographics and the Health Insurance Literacy Measure (HILM), a continuous measure ranging from 0-84 (higher scores indicate higher comfortability and literacy). Associations of age (18-25 vs. 26-39) and policy holder (yes vs. no) with HILM score were evaluated with t-tests. Results: AYAs (N = 24) were nearly even by gender, female (58%), primarily heterosexual (92%), Non-Hispanic White (79%), and had at least some college (92%). Less than half of participants were policy holders (41.7%). Three themes emerged from analysis: 1) Lack of knowledge and experiential learning throughout treatment, 2) Unclear expectations of health insurance, and 3) Difficulties navigating coverage and the complex systems. Most AYAs were unaware of the specifics of their coverage and how their insurance plan impacted their costs. Most AYAs were surprised at the lack of coverage and high costs they encountered during treatment. Most AYAs experienced substantial difficulty navigating coverage issues, particularly the appeals process. The mean HILM score was 55.63 (SD = 10.06), no differences by age group or policy holder status. Conclusions: AYAs with cancer report substantial difficulty navigating the complex health insurance system and demonstrate low levels of health insurance literacy. Health insurance education focusing on insurance concepts (e.g., cost-sharing mechanisms) may help AYAs better manage costs and enable them to make informed health insurance decisions despite being at higher risk for financial toxicity.
Exploring the three domains of financial hardship experienced by ovarian cancer patients.
Authors: Liang Margaret Irene , Simons Janice Leahgrace , Herbey Ivan I. , Wall Jaclyn , Rucker Lindsay , Ivankova Nataliya V. , Huh Warner King , Pisu Maria 
Published: October 2020

71 Background: We sought to obtain ovarian cancer patients’ perspective on the 3 domains of financial hardship (psychological response, material conditions, and coping behaviors). Methods: We recruited ovarian cancer patients on systemic therapy who screened positive for financial distress using Comprehensive Score for Financial Toxicity (COST) <26. Two interviewers conducted 45-minute interviews about patients’ experiences dealing with the costs of care. Interviews were recorded, transcribed, and coded by 3 analysts using inductive thematic analysis to identify common themes. Results: 22 patients completed interviews with 18 available for analysis. Median age was 57 years old, 36% were black, and participants had a median COST of 12 (range 0-23). We identified themes within each domain (Table). Conclusions: Ovarian cancer patients predominantly experienced financial hardship through psychological response and negative impact on their material conditions. These require increased provider awareness and targeted interventions. Patients did not report negative health-related coping behaviors as they prioritized their health care over immediate cost concerns. [Table: see text]
Effectiveness of immunotherapy given to cancer patients in the hospitalized setting.
Authors: Araoye Mojisola O , Byrne Brian J. 
Published: October 2020

74 Background: Immunotherapy is a type of cancer treatment that uses an individual’s immune system to fight cancer. Most clinical trials involving immunotherapy have been done on healthy patients, thus excluding many hospitalized patients. Many oncologists feel there are less significant toxicities to immunotherapy and thus may give them to sicker patients. This may delay discussions regarding goals of care and contribute to increased costs at end of life. This exploratory study focuses specifically on the use of immune checkpoint inhibitors in hospitalized patients to determine outcomes of patients treated in the inpatient setting. Methods: This is a retrospective chart-review study. Data on patients from the Hartford Healthcare system was extracted from EPIC. Patients were eligible if they had received at least one dose of a PD1 or PDL1 inhibitor (pembrolizumab, nivolumab, atezolizumab) during a hospital stay. The number of doses received in total, side effects, as well as discharge status was also recorded. Results: A total of 74 patients received at least one dose of a PD1 or PDL1 inhibitor during a hospital stay. 46% of the total patients treated either died in the hospital (16.2%) or were discharged to hospice (29.3%). 54 percent of patients were discharged with a plan to continue with therapy. For the subgroup of the 27 patients whose treatment was initiated in the hospital, 48% of them received only one cycle of treatment and 74% received less than 4 treatments total. The average number of cycles was 5.3. The percentage of patients who died in the hospital was 11.1% and the percentage of patients discharged to hospice was 33.3%. 55.5% were successfully discharged with a plan to continue with therapy. Conclusions: For patients who receive immunotherapy in the hospital setting there is a questionable benefit with more than 45% dying in the hospital or being discharged to hospice. Further evaluation can be done looking at increasing the cost, delaying palliative care, and patient/family satisfaction with their end of life care by giving immunotherapy in the hospital. A new quality measure looking at time from last immunotherapy to hospice enrollment or death may need to be followed in the future due to these poor outcomes in the hospitalized setting. [Table: see text]
Financial and employment toxicity related to breast reconstruction following mastectomy in a diverse population-based cohort.
Authors: Berlin Nicholas L. , Momoh Adeyiza O. , Abrahamse Paul , Katz Steven J. , Jagsi Reshma , Hawley Sarah T. 
Published: October 2020

78 Background: Despite mandated private insurance coverage for breast reconstruction following mastectomy, health care costs are increasingly passed onto women who seek these procedures through cost-sharing arrangements and high-deductible health plans. In this population-based study, we sought to characterize financial and employment toxicities related to pursuing breast reconstruction following mastectomy. Methods: Women (white, African American, and Latina-English and Spanish speaking) with early stage breast cancer (stages 0-II) diagnosed between July 2013 to September 2014 and who underwent mastectomy were identified through the Georgia and Los Angeles Surveillance, Epidemiology, and End Results (SEER) registries and surveyed. Primary outcome measures included patient-reported appraisal of financial toxicity and employment status following breast cancer treatment using previously developed measures. Multivariable models evaluated the association between breast reconstruction and self-reported financial and employment status. Results: Among 868 breast cancer patients who underwent mastectomy, 43.5% (n = 378) did not undergo breast reconstruction and 56.5% (n = 490) underwent reconstruction. 43.4% of the cohort reported being worse off financially since their diagnosis (49.4% with reconstruction vs. 35.0% without reconstruction, P< .001). Among women who were employed at time of breast cancer diagnosis (n = 535), 70.2% who underwent reconstruction reported being worse off regarding employment status compared to 51.1% who did not undergo reconstruction ( P< .001). Receipt of reconstruction was independently associated with a self-reported decline in financial status (Odds Ratio (OR) 2.1, 95% Confidence Interval (CI) 1.4-3.4, P= .001). Similarly, reports of being worse off regarding employment status were also higher in those who underwent reconstruction vs. not (OR 2.2, 95% CI 1.2-3.8, P= .006). Spanish-speaking Latina women more often reported being worse off regarding employment status (OR 4.3, 95% CI 2.1-9.0, P< .001) than white women. Conclusions: In this diverse cohort of women who underwent mastectomy for early stage breast cancer, women who elected to undergo reconstruction experienced more self-reported financial and employment toxicities. Patients should be counseled regarding the potential costs related to these procedures. Policy-makers should be aware of the financial barriers for women who undergo reconstruction despite mandatory insurance coverage in the United States.
Disparities in the use of telehealth during the COVID-19 pandemic.
Authors: Smith Cardinale B. , Bhardwaj Aarti Sonia 
Published: October 2020

87 Background: New York City was the epicenter of the COVID-19 pandemic. Public concern about exposure and policies to “flatten the curve” led to abrupt curtailment of health care service use, including cancer. Innovative strategies to mitigate the disruption, including telemedicine, was utilized. However, this may be less accessible to minority populations. We evaluated the differences in telehealth use among minorities and non-minorities with cancer. Methods: Our health system includes an NCI designated cancer center and 8 ambulatory sites across New York City. Utilizing the electronic medical record (EMR) we collected data on all cancer patients with an in-person or telehealth visit during the peak of the pandemic from March 1, 2020 to June 1, 2020. Race/ethnicity and visit type data was collected from the EMR. Telehealth includes video visits and telephone encounters. We used ANOVA and-chi square where appropriate to identify differences between the racial and ethnic groups in terms of use and type of telehealth and compared any differences to baseline cancer center demographics. Results: There were a total of 7,681 telehealth visits during 3/1/2020-6/1/2020; 76% were video visits. At baseline in 2019, < 1% of all patient visits were conducted via telehealth. Within our cancer center our demographic breakdown for patients seen in 2019 includes 42% patients were white, 23% Black, 14% Hispanic and 7% Asian. Among those patients utilizing video visits, 50% patients were white, 17% Black, 8% Asian, and 5% Hispanic. Among those patients utilizing phone encounters, 43% patients were white, 23% Black, 7% Hispanic and 6% Asian. Conclusions: During the COVID-19 pandemic our utilization of telehealth increased exponentially. There were significant disparities observed in the use of telehealth with Black, Hispanic and Asian patients having less utilization. These findings are important as telehealth use will now become more integrated into standard oncologic care, and it is likely that we will have a second or third wave of COVID-19 infections. Future work to understand the determinants of these disparities and interventions are needed. [Table: see text]
Factors associated with clinical trial participation for patients with prostate cancer.
Authors: Shinder Brian , Kim Sinae , Patel Hiren V. , Srivastava Arnav , Mayer Tina M. , Saraiya Biren , Singer Eric A. 
Published: October 2020

96 Background: Clinical trials are critical for the development of new treatment paradigms for Prostate Cancer (PCa). The primary aim of this study was to characterize the factors associated with clinical trial participation for patients with PCa. The secondary objective was to examine survival outcomes in the clinical trial and control cohorts. Methods: The National Cancer Database (NCDB) was queried for patients with PCa who were coded as having enrolled in a clinical trial. Trial patients were matched in a 1:8 ratio to controls based on clinical stage. Sociodemographic variables were compared between the two groups and univariate and multivariate logistic regression models evaluated factors associated with clinical trial participation. Kaplan-Meier product limit estimate was used to compare overall survival (OS) between the groups. Results: From 2004-2015, 495 patients enrolled in clinical trials were included for analysis. The mean age of trial patients was 63.2 compared to 66.4 in the matched cohort (p < 0.0001). More patients in the trial group had a Charlson-Deyo comorbidity score of 0 (89.3% vs. 82.1%, p = 0.0002). On multivariate analysis, patients who traveled between 50-250 miles (OR 1.59; 95%CI 1.15-2.19, p = 0.005) or came from a zip code where greater than 93% of the population has a high school degree (OR 4.97; 95%CI 2.89-8.54, p < 0.0001) were more likely to participate in a clinical trial. There was no association between race and insurance status on clinical trial participation. Median OS was not significantly different among clinical trial participants than the control cohort (120.9 months vs. not reached, p = 0.928). Conclusions: In this contemporary analysis of PCa patients from a national hospital registry database, we found that certain patient sociodemographic factors remain associated with clinical trial participation, though clinical trial participants do not seem to experience a difference in OS. Further work, both qualitative and quantitative, is necessary to identify clinical and non-clinical barriers to research participation in order to improve the validity of PCa trials.
The association between Medicare’s next generation sequencing (NGS), national coverage decision (NCD), and NGS utilization.
Authors: Wong William Bruce , Sheinson Daniel , Ogale Sarika , Flores Carlos , Gross Cary Philip 
Published: October 2020

98 Background: In 2018, Medicare released a NGS NCD memo which would facilitate reimbursement for NGS tests for patients (pts) with advanced or metastatic cancer who had not been previously tested using NGS for the same cancer and genetic content. We examined the association between the NCD and: a) NGS utilization trends in commercially-insured and Medicare pts and b) repeat NGS testing. Methods: We conducted a retrospective study of pts with advanced non-small cell lung cancer (aNSCLC), metastatic colorectal cancer (mCRC), metastatic breast cancer (mBC) or advanced melanoma (aM), diagnosed 2011 (2013 for mCRC) through Dec. 2019 using the Flatiron Health EHR-derived de-identified database, comprising data from over 280 (largely community based) cancer clinics (~800 sites of care). Pts were classified as Medicare or Commercially insured based on age and insurance type, and grouped into quarters based on their advanced or metastatic diagnosis date. NGS testing rates per quarter were based on evidence of first NGS test within 60 days from diagnosis. We used an interrupted time series analysis to assess NGS utilization trends pre- and post-NCD policy effective date (March 2018). The frequency of repeat NGS testing was assessed among those pts with only 1 primary cancer. Results: The utilization analysis included 70,290 pts while the repeat NGS testing analysis included 51,385 pts. Across the 4 tumors combined, the use of NGS was < 1% in 2011 (both insurance types) and increased to 41% in commercially-insured pts and 37% in Medicare in 2019. In each tumor, NGS utilization was < 6% in Q1 2014; however, the rate of increase varied by tumor, with aNSCLC increasing to 58% in commercial and 48% in Medicare, while mBC and aM remained < 20% in Q4 2019. Among pts with aNSCLC, mCRC, or mBC, the quarterly rate of increase in NGS testing was higher post-NCD compared to pre-NCD (p < 0.05 for pre-post difference in rate of NGS increase within each cancer type). The difference in trends pre- and post-NCD was not significantly different between commercial and Medicare in any of the tumors (p > 0.05 within each cancer type). Repeat NGS testing increased over time from 17.8% (in Q3 2014 to Q2 2016) to 29.6% (in Q2 2018 to Q4 2019). Conclusions: NGS utilization trends significantly changed post-NCD, however the rate of change was not significantly different by insurance, indicating private insurers may also be following the guidance of the NCD. We observed an increase in repeat NGS testing, despite the NCD not covering repeat testing with the same NGS test.
Effects of Intermittent Fasting or Calorie Restriction on Markers of Lipid Metabolism in Human Skeletal Muscle
Authors: Liu Bo , Hutchison Amy T , Thompson Campbell H , Lange Kylie , Wittert Gary A , Heilbronn Leonie K 
Published: October 2020

AbstractContextImpaired lipid metabolism is linked with obesity-associated insulin resistance, which may be reversed by caloric restriction (CR).ObjectiveIn a secondary analysis of a randomized controlled trial, we compared the effects of intermittent fasting (IF) and CR on markers of lipid metabolism in muscle.DesignSeventy-six women (body mass index, 25-40 kg/m2) were randomly assigned to 1 of 3 diets for 8 weeks and provided foods at 70% (CR70 and IF70) or 100% (IF100) of energy requirements. IF groups ate breakfast prior to a 24-hour fast on 3 nonconsecutive days per week. On nonfasting days, IF70 ate at 100% and IF100 ate at 145% of energy requirements to achieve the prescribed target. Weight, body composition, insulin sensitivity by clamp, nonesterified fatty acids (NEFAs), β-hydroxybutyrate (BHB), and markers of lipid metabolism and oxidative stress in muscle by quantitative polymerase chain reaction were measured at baseline and week 8 following a 12-hour overnight fast (all groups) and 24-hour fast (IF groups).ResultsIF70 resulted in greater weight and fat loss and reduced NEFAs vs CR70 and IF100 after an overnight fast. IF70 and IF100 induced a greater reduction only in mRNA levels of antioxidant enzymes glutathione peroxidase 1 (GPX1), superoxide dismutase 1, soluble (SOD1), and SOD2 vs CR70. Fasting for 24 hours increased NEFAs and BHB in IF groups, but impaired insulin sensitivity and increased PLIN5 mRNA levels.ConclusionsIn comparison to CR, IF did not increase markers of lipid metabolism in muscle, but reduced expression of antioxidant enzymes. However, fasting-induced insulin resistance was detected, alongside increased PLIN5 expression, potentially reflecting transient lipid storage.