bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers identified in a patient navigation program for starting and completing definitive radiotherapy treatment in a limited resource setting.
Authors: Vieira Carolina Martins , Krush Lindsay , Goss Paul E. , Rodrigues Angelica Nogueira 
Published: May 2020

e19018 Background: In addition to limited radiotherapy (RT) resources, there is enormous complexity involved in the registration process for attending RT services in Brazil. The process involves so many steps that, in combination with the lack of information and guidance, makes the patients often get lost within the system. Hospital das Clínicas da UFMG (HC UFMG) is a teaching hospital that belongs to the 3rd largest university in Brazil and, despite its important cancer center, it does not have its own radiotherapy center. That makes the RT process even more complex, since the patient ends up receiving chemotherapy in one center and RT in another, a common scenario in low- and middle-income countries (LMICs).Thus, it is necessary to optimize the scarce resources available, taking also into account the social difficulties involved. Patient barriers to accessing care were evaluated throughout a patient navigation (PN) study in Brazil, in order to better help the navigator identify areas of possible intervention. Methods: In a pilot study (non-randomized) carried out in partnership with the Global Cancer Institute, patients with cancer of the cervix, rectum, esophagus, anal canal, head and neck, lung, and prostate who were considered candidates for neoadjuvant or definitive RT were evaluated and questionnaires were applied to identify obstacles for RT, in order to guide a PN program and help to orient health policies. Results: Seventy-three patients were interviewed (1 excluded). The majority had locally advanced disease, the most prevalent sites being esophagus, head and neck and rectum. The most common barriers are shown in the table. 100% of the patients reported at least one obstacle, 93% between 2 and 7 obstacles and 1 patient quoted 13 of them. Conclusions: Proper identification of barriers involved in treatment, especially in a low resource setting is mandatory in order to guide PN program`s goals and establish public health demands. Many barriers identified may be overcome with PN programs in LMICs. [Table: see text]
Change in body mass index in breast cancer patients in the first two years from diagnosis.
Authors: Abu-Khalaf Maysa M. , Shimada Ayako , Nikita Nikita , Micaily Ida , Hackbart Hannah , Lu-Yao Grace L. , Butryn Meaghan 
Published: May 2020

e19020 Background: The rate of obesity in adults is 34% in the city of Philadelphia, with rates being highest among non-Hispanic blacks and Hispanics. We sought to evaluate how BMI varies by age and race/ethnicity at time of initial encounter for a breast cancer (BC) diagnosis (dx), and investigate factors predictive of BMI change in the first 2 years of dx. Methods: We identified 1,833 patients (pts) in our electronic medical record, (1/2015-present), who had a BC dx at their first hospital or ambulatory encounter using ICD-10 code C50.X, and had BMI recorded at baseline (BL) (6 mo pre-and up to 3 mo post), at 1 yr +/- 3 mo and 2 yr +/- 6 mo. We summarized demographic data (age, gender, marital status, race/ethnicity) with mean and standard deviation for continuous variables and with count and percentage for categorical variables. Descriptive statistics were summarized by 3-level BMI categories: underweight/normal (≤ 24.9), overweight (25 to 29.9), and obese (>30) and compared with ANOVA test, Chi-square-test or Fisher’s exact test as appropriate. Mixed effect regression analysis was conducted to adjust for the effects of time (i.e., BL, 1 yr, 2 yr), gender, race/ethnicity and the interaction of time and race and ethnicity in estimating mean BMI. We calculated the mean change of BMI between the BL and later time points by race/ethnicity. The significance level of all tests was set a priori to the 0.05 level. Results: 99.4% of pts were female; mean age was 63 yrs; White (60 %), Black/AA (27 %). By BMI category, we did not observe a substantial difference in the mean age of dx and gender (p = 0.18 for age and p = 0.55 for gender). We observed a substantial difference in race/ethnicity among BMI categories (p < .0001); the highest percentage of obese pts were Black/AA. In the mixed effect model, the reference level was set as a white female with an average (avg) systolic blood pressure of 137.8. The estimated avg BL BMI of this reference group was 28.8. We observed that among Asian/Pacific Islander (API) pts the avg BL BMI is lower by 3.5 ( p < .0001) and among female Black/AA pts the avg BL BMI is higher by 2.6 ( p < .0001) compared to reference group. No significant change was noted in mean BMI between BL and 1 yr for any race and ethnicity group, and only the Hispanic/Latino group had a declining trend for change in BMI between BL and 2 yr (estimate: -1.9; 95% CI: -5.9, 2.1). Conclusions: In our cohort, Black/AA pts likely have higher BL BMI and API pts likely have lower BL BMI compared to White pts. We found no significant difference in change of BMI by race and ethnicity group during the first 2 years from an initial encounter for a BC dx.
Exclusion rates of patients living with HIV from cancer immunotherapy clinical trials.
Authors: Vora Kruti Bhagirath , Awad Mark M. 
Published: May 2020

e19035 Background: Although patients living with HIV are at increased risk for developing several cancers, they have often been excluded from practice-changing immunotherapy clinical trials across many tumor types. Emerging retrospective and prospective studies indicate that immunotherapies can be safe and effective in patients with HIV. ASCO and Friends of Cancer Research have supported the inclusion of patients with HIV in cancer clinical trials. We determined the rate of HIV exclusion from recent cancer immunotherapy clinical trials according to tumor type, immunotherapy treatment, and phase of trial. Methods: We compiled trials on the ClinicalTrials.gov database with study start dates from January 1, 2019 to October 10, 2020, using the search term “cancer” for disease, and the following intervention terms: “immunotherapy, PD-1, PD-L1, CTLA-4, pembrolizumab, nivolumab, atezolizumab, durvalumab, avelumab, cemiplimab, ipilimumab, tremelimumab, sintilimab, spartalizumab.” Observational studies and trials not offering immune checkpoint inhibitors (ICIs) or cellular immunotherapy were excluded. Eligibility criteria for each trial were reviewed to determine rate of exclusion for HIV, human immunodeficiency virus, acquired immunodeficiency, or immune deficiency. Cellular immunotherapies were defined as modified T cell, dendritic cell, NK cell, or other peripheral blood leukocyte treatments. Results: Of 1090 analyzed trials, 795 (72.9%) specifically excluded patients with HIV, and another 80 (7.3%) trials included patients with HIV only if certain criteria were met (e.g. undetectable viral load, minimum CD4+ T cell count). By tumor type, the rate of HIV exclusion ranged from 60.9% (renal cancer) to 85.7% (cervical cancer), with hematologic malignancies having a significantly higher rate of HIV exclusion than solid tumor trials (85.2% vs. 73.3%, p = 0.015). Trials combining ICIs with cellular immunotherapies were more likely to exclude HIV (N = 22, 90.9% exclusion) than trials with ICIs alone (N = 1003, 71.4% exclusion, p = 0.044). Phase I (N = 271, 73.1% exclusion, p = 0.0012), I/II (N = 165, 70.9% exclusion, p = 0.010), and II trials (N = 519, 77.5% exclusion, p < 0.0001) had higher rates of exclusion than phase III trials (N = 101, 55.4% exclusion). Conclusions: Despite ASCO and Friends of Cancer Research recommendations to include patients with HIV in cancer clinical trials, the vast majority of immunotherapy clinical trials in 2019 exclude patients with cancer and HIV.
Differences in self-reported health-related quality of life in heterosexual and sexual minority women surviving cancer: 2013 to 2018 national health interview survey.
Authors: Hutchcraft Megan Leigh Gleason , Patterson Joanne G , Teferra Andreas A , Montemorano Lauren , Backes Floor Jenniskens 
Published: May 2020

e19038 Background: Health related quality of life (HRQoL) is associated with excess morbidity and mortality after cancer diagnosis. While a growing body of research indicates that sexual minority women (lesbian and bisexual women; SMW) experience greater risk for cancer diagnoses and cancer-related mortality, there is a paucity of evidence describing HRQoL in this population. This is a critical omission as assessment of sexual orientation differences in HRQoL may inform clinical interventions to improve health and survival of SMW after cancer diagnosis. This study examined associations between sexual orientation and HRQoL domains among female cancer survivors. Methods: Data from the 2013-2018 National Health Interview Survey (NHIS) was pooled. HRQoL was defined using individual indices across physical health, mental health, social, and financial domains. The association between sexual orientation and individual indices of HRQoL was assessed using weighted multivariable logistic regression analyses. Results: The sample included 97909 heterosexual, 1424 lesbian, and 1235 bisexual women who reported a cancer diagnosis. Sexual minority women were more likely to be college graduates (p < 0.001) and employed (p < 0.001); however, they had higher rates of being uninsured (p = 0.01) than their heterosexual counterparts. Reproductive cancers—including breast, ovarian, cervical, and uterine—accounted for 51% of cancer diagnoses in heterosexual women and 57.2% in SMW (p = 0.06). Sexual minority and heterosexual women had more similarities than differences in individual indices of HRQoL; however, several pertinent differences were noted. Specifically, SMW had higher odds of moderate (OR 1.46 [1.01-2.13]) and severe psychological distress (OR 2.10 [1.17-3.77]); chronic health conditions, including COPD (OR 1.72 [1.06-2.80]) and heart disease (OR 1.93 [1.32-2.83]); financial concerns about retirement (OR 1.36 [1.01-1.83]); food insecurity (OR 2.13 [1.23-3.68]), and severe food insecurity (OR 2.44 [1.28-4.67]). Conclusions: Sexual minority women with cancer diagnoses report worse indices of HRQoL. Poorer HRQoL may influence excess morbidity and mortality evidenced in these populations; however, future longitudinal studies are needed to assess prospective risk. Given our results, implementing interventions in the cancer setting to identify sexual minority patients in need of physical and mental health and financial services may reduce disparities.
Psychological distress, social function and financial burden of cancer patients receiving treatment in an African setting.
Authors: Tolani Musliu Adetola , Abur Peter Pase , Daniyan Muhammad , Nwabuoku Stanley Emeka , Mustapha Aisha , Bashiru Mutiu 
Published: May 2020

e19048 Background: The improvement in the quality of cancer treatment is key to increasing survival. However, the functional well-being of these patients is equally important. This study aimed to assess the degree of psychological distress, social function and financial burden in patients undergoing cancer treatment in our center. Methods: A cross-sectional study was designed to prospectively recruit patients in our teaching hospital between December 2019 to February 2020. Those with cancer, aged 18 years and above, who had surgery, chemotherapy and (or) radiotherapy for treatment were included while those who had not commenced cancer treatment were excluded. Information on their clinicopathologic characteristics was obtained. The degree of psychological distress was assessed using a distress thermometer (DT) based on an 11-point scale. Social function was assessed using validated SCARF social functioning index (SSFI) (Cronbach's alpha = 0.818) which has 4-domains, each with scores ranging from 0 (very poor) to 4 (very good). Financial burden (FB) was assessed on a 5-point Likert scale. SPSS was used for data analysis with p < 0.05 considered significant. Results: Seventy-two patients were analyzed with a mean age of 50.3 ± 13.7 years and male to female ratio of 0.8:1.0. The median time from diagnosis was 6.0 (2.5 – 16.0) months and 51 (70.8%) were on palliative treatment. The median psychological distress score was 6.0 (4.0 – 8.0) while the mean SSFI score was 12.0 ± 3.3. Relationship with immediate family (3.4 ± 0.7) had a significantly higher sub-score than two other domains (occupational role: 2.3 ± 1.4, p < 0.001; self-concern/care: 3.0 ± 1.0, p < 0.001). Fifty patients (69.4%) had heavy or extreme financial burden with 34 (47.2%) admitting to income reduction since onset of therapy. Female sex (p < 0.001, 95% CI: 1.246 – 3.597), higher ECOG score (p = 0.033, 95% CI: 0.061 – 1.383) and palliative treatment (p = 0.038, 95% CI: 0.084 – 2.768) were independent predictors of psychological distress. Conclusions: Despite the marked psychological distress and huge financial burden in patients receiving cancer treatment in this setting, they still maintained a relatively normal status in most of the social function domains.
Disparities in advanced stage breast cancer: The socioeconomic and geographic contributions.
Authors: Clemons Kelli , Forehand William , Xu Hongyan , Zhang Li Fang , Raval Priyanka 
Published: May 2020

e19055 Background: Socioeconomic disparities in healthcare have been well documented in America, with cancer being a critical area. One in four deaths are caused by cancer, and the effects on different communities are not equal. Clinical observations suggest that poorer socioeconomic circumstances lead to more frequent, later stage diagnoses and worse outcomes. The aim of this project was to quantify the sociodemographic and geographic contributions to disparities in advanced, metastatic breast cancer within the Augusta population and surrounding areas. Methods: Records of patients managed for breast cancer at the Georgia Cancer Center between Jan 2009- Jun 2019 were reviewed. 80 patients who presented with early stage breast cancer (clinical stage I) without positive lymph nodes were compared with 80 patients who presented with advanced, metastatic disease (clinical stage III-IV). Their race, breast cancer characteristics, insurance status, geographic proximity to a mammography site or major healthcare facility, and time interval between diagnosis and treatment were compared. Results: Results show that 73.75% early stage patients had private insurance, while 41.25% late stage patients had private insurance (p value < 0.0001). The early stage patients were 4.0 times more likely to have private insurance than late stage patients. Results also show that 25.0% of late stage patients had annual mammography screenings, while 77.78% of early stage patients had regular screening for mammograms (p value < 0.0001). The late stage patients were 1/10 as likely to have regular screening for mammogram as early stage patients. 80.6% of patients that received regular mammograms had private insurance, while the remaining 19.4% of those patients had public insurance. No statistical difference was shown in late and early stage presentation based on HER2 and/or triple negative (ER-, PR-, HER2-) status. Conclusions: There is a significant outcome of advanced, metastatic breast cancer in patients that do not have private insurance and in those that do not receive regular mammograms. Our findings support the importance of investing resources into alleviating differences in various socioeconomic populations as they relate to the amount and quality of cancer healthcare available. While the incidence of mortality in breast cancer is decreasing nationwide, disparities in morbidity and mortality will most likely continue unless there is an aggressive effort towards addressing said differences.
The comparative effectiveness of biologic agents among non-hispanic black (NHB) patients with metastatic colorectal cancer (mCRC): Preliminary results of a SEER-medicare analysis.
Authors: Goel Sanjay , Negassa Abdissa , Acuna-Villaorduna Ana 
Published: May 2020

e19059 Background: Biologic agents (bevacizumab, cetuximab, panitumumab) have improved the overall survival (OS) of patients with mCRC. However, clinical trials are plagued by low representation of NHB patients, and a disproportionately high (>90%) accrual of non-Hispanic whites (NHW). As a result, the real world benefit among NHB patients in unknown. Comparative effectiveness research is an approach for effectively addressing this drawback. Methods: Utilizing the SEER-Medicare linked database, we identified 5,728 patients with mCRC diagnosed between 2004 and 2011 who received chemotherapy (CT; oxaliplatin, irinotecan, 5-FU, capecitabine) alone or chemotherapy with a biologic agent (CBT). OS was examined using the Kaplan-Meier method and a weighted semi-parametric accelerated failure time model. A propensity score model approach was undertaken to further account for potential treatment selection bias. Results: Overall, 88% were NHW and 12% NHB patients. The median age at diagnosis was 73 and 70 years and exposure to biologics was 71.2% and 71.4%, respectively. NHB patients had more women, were single, had lower median incomes, better differentiated tumors, less rectal primary cancers, more right sided tumors, and a worse Charleson co morbidity index. There was no difference in the receipt of 1 (72%) vs > 2 (28%) lines of therapy. The median OS was 11 and 12 months (m) in the CT-alone group, and 21 and 22 m in CBT group, among NHW and NHB, respectively. Based on an unadjusted analysis, receipt of biologics, younger age, left sided primary, well/moderate differentiation, being married, more lines of CT, and lower prevalence of co-morbidity were associated with improved OS. We also performed multiple imputations to properly account for the missing data. Among NHW, median OS was 21 vs 11 m in the CBT and CT groups, respectively (effect 1.47, 95% CI 1.36-1.60, p = 0.0000). Among NHB, median OS was 22 vs 12 m in the CBT and CT groups, respectively (effect 1.48, 95% CI 1.23-1.88, p = 0.0000). All comparisons maintained significance when adjusted for multiple comparisons. We found no interaction between biologics and race (p = 0.8743). On subgroup analysis, those patients receiving both classes of biologics (anti EGFR and anti VEGF) had the best outcome. Conclusions: In this cohort of older patients, CBT was associated with longer survival, regardless of race. Clinicians should offer CBT therapy to all patients to maximize their clinical benefit, factoring in clinical variables, but not their race.
A single institution study on the demographics and response rates of Hispanic women with HER2+ disease.
Authors: Cholankeril Michelle , Smith Keia 
Published: May 2020

e19069 Background: Hispanics have 20% lower incidence of breast cancer than the general US population. Despite this, breast cancer is the leading neoplasm seen in Hispanics and is a significant cause of their mortality. Our study reports the incidence and outcome of HER2 breast cancer, use of a neoadjuvant regimen, and surgery type in the Hispanic population at our urban institution. Methods: This study reports on 37 women that were diagnosed with HER2+, non-metastatic breast cancer from 2015-2019. We report this as a single institution, community program that provides equal access healthcare and delivery. Our data was investigated and compiled using our facility’s cancer registry. The patient sample included 20(54%) Hispanics, 13(35%) African Americans, 3(8.0%) Caucasians and 1(3%) Asian. Of the 20 Hispanic women, 85% were Estrogen Receptor (ER) positive and 48% were Progesterone Receptor (PR) positive. Eleven (55%) of the 20 Hispanic patients(pts) received neoadjuvant chemotherapy (NAC), which included regimens containing Trastuzamab (H) with or without Pertuzumab(P). Our remaining 9 pts receiving adjuvant therapy were investigated for response as well. Results: Our Hispanic pts receiving NAC had an overall complete response rate of 45% and a partial response rate of 55%. There appeared to be no significant difference in response rate in Hispanic women between the HP group versus H. NAC pts had fewer partial mastectomies performed than those not receiving NAC. Hispanic NAC patients were found to have significantly more sentinel lymph node dissections (SLND) 7(88%) versus axillary lymph node dissections 1(16%) compared to other ethnicities receiving NAC. Non NAC Hispanic patients had 56% sentinel lymph node dissections, compared to 44% complete axillary dissections. Conclusions: The results indicate that there is a significant Hispanic population at our facility that harbor the HER2 oncogene. These pts seem to have a promising response to the NAC regimen in regards to SLND. We hope to have a larger patient sample through a multi-institution study, with statistical analysis to support our current findings. More studies should be performed on Hispanic women with HER2 disease, as data with this subset of population is lacking. The NAC regimen should be greatly considered and implemented in the treatment in those looking to downstage axillary disease. We hope to further investigate treatment options for Hispanic pts to gain greater pathological responses, leading to improved progression free and disease free survival that match that of other ethnic groups.
Using implementation science to examine impact of a social responsibility agenda on addressing cancer health disparities in Ceará, Brazil.
Authors: Rocha Hermano Alexandre Lima , Dankwa-Mullan Irene , Meneleu Pedro , Juaçaba Caio Figueiredo , Solomon Metasebya , Boni Debora , Lopes Silvia Helena de Souza , de Souza Silvia Elaine Miranda , Ximenes Mylena Silvia , Thé Rebeca Rodrigues , Lacerda Leandro Freire , Oliveira Erick Siqueira Campos de , Clark Cheryl , Felix Winnie , Arriaga Yull Edwin , Silva Marcelo Gurgel Carlos da , Jackson Gretchen Purcell , Juaçaba Sergio Ferreira 
Published: May 2020

e19071 Background: Programs to address disparities in cancer care outcomes in resource-limited settings require attention to social determinants of health (SDoH) to achieve successful clinical care implementation. The Instituto de Câncer do Ceará, the largest cancer center in northeastern Brazil, has implemented a Social Responsibility Agenda (SRA) to guide equitable cancer care delivery. This goal of this study was to develop a framework for an implementation science (IS) study evaluating the longitudinal impact of the SRA on cancer outcomes. Methods: We outlined a mixed-methods and participatory study incorporating a process model, the Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation framework. A list of constructs and links to measurement tools associated with IS models were identified to guide the study phases. Results: We established a logic model to guide in evaluating the health and economic impact of the SRA. We identified >30 constructs and measures across domains of IS models. The table shows a driver diagram to inform the framework. Conclusions: Understanding determinants, key drivers and change concepts are important initial steps in an ongoing evaluation of the impact of evidence based SDoH interventions to address cancer disparities. [Table: see text]