bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of survival with chemotherapy intensity, myelosuppression, and supportive care in patients with advanced solid tumors.
Authors: Lyman Gary H. , Poniewierski Marek S. , Wogu Adane Fekadu , Culakova Eva , Kuderer Nicole Maria , Crawford Jeffrey , Dale David C. 
Published: March 2020

6534 Background: The value of chemotherapy and supportive care for advanced cancer has been questioned. Two systematic reviews were conducted to study the impact of chemotherapy-induced myelosuppression and supportive care on subsequent survival. Methods: Phase 1 identified trials evaluating the relationship of chemotherapy associated with myelosuppression and subsequent survival in patients with cancer. Phase 2 evaluated randomized controlled trials (RCTs) chemotherapy with or without G-CSF support for advanced cancer. Outcomes included hazard ratios (HR), relative risk (RR) and absolute risk (AR) ±95% CI. Results: In Phase 1, 11 of 25 identified studies were conducted in patients with advanced/metastatic disease with 10 in patients with solid tumors. Among the 7 studies in patients with solid tumors reporting survival outcomes, a consistent association between chemotherapy-associated myelosuppression and reduced mortality was observed (HR=0.69; 0.61-0.77; P<.0001). A significant interaction between myelosuppression and cancer type for mortality was observed (P=.046) with significant effects observed for all tumor types. In Phase 2, 22 of 61 RCTs identified were in patients with stage IV solid tumors. Mortality was reduced with chemotherapy with G-CSF support overall (RR=0.95; 0.92-0.98; P=.003) and in patients with non-small cell lung cancer (RR=0.90; P=.037; AR=-6.6%; P=.014), sarcomas (RR=0.73; P=.007; AR=-22.1%; P=.004) or urothelial cancers (RR=0.87; P=.019; AR=-11.4%; P=.016). Reductions in mortality were seen with dose dense chemotherapy (RR=0.88; P=.021; AR=-10.0%; P=.019) and when survival was the primary outcome (n=11;RR=0.92; P=.022; AR=-5.2%; P=.001) with a trend toward greater benefit with longer duration of follow-up (P=.071). Conclusions: Studies of patients with advanced solid tumors demonstrate favorable effects of chemotherapy effect on survival. Chemotherapy treatment resulting in myelosuppression is associated with reduced mortality. RCTs of patients with advanced/metastatic solid tumors confirm that greater chemotherapy dose intensity with G-CSF support is associated with greater reductions in mortality.
Trial prospector: An automated clinical trials eligibility matching program.
Authors: Parchman Andrew J. , Zhang Guo-Qiang , Mergler Patrick , Barnholtz-Sloan Jill , Lanese Robert , Miller Dawn M. , Opper Chris , Sahoo Satya , Tao Shiqiang , Teagno Joseph , Warfe James , Meropol Neal J. 
Published: March 2020

6538 Background: Clinical trials are the evidence base for improving cancer treatment. Unfortunately, only approximately 5% of cancer patients (pts) take part in clinical research studies. Even in settings where clinical trials (CTs) are available, pt participation remains low. We hypothesize that the time required to identify appropriate studies for individual pts is a significant barrier to clinical trial accrual. Methods: Our multidisciplinary team developed Trial Prospector (TP), an innovative and flexible computer-based system that utilizes artificial intelligence and natural language processing to automatically extract information (e.g. demographics, pathologic diagnosis, stage, labs) from multiple clinical data systems and then match it to CT eligibility criteria. A user-friendly interface allows physician perusal of relevant CTs and eligibility checklists at the point of care without requiring manual data entry. We pilot tested TP in our cancer center GI oncology subspecialty clinics. TP was deployed for consecutive new pts, and oncologists (oncs) completed surveys after each visit to assess the usability and impact of TP. Results: Eleven medical oncologists (6 attendings and 5 fellows) participated in the pilot study. TP was deployed during 60 new pt visits. Of the 15 relevant GI/phase I CTs, TP identified a mean of 7 ± 2.7 eligible trials per patient. The most common reasons for ineligibility were pathologic diagnosis and labs. CTs were considered by the treating onc for 66.7% of the pts. 95% of participating oncs reviewed the TP output at the point of care with 70% spending 0-5 minutes assessing eligibility. Of the pts considered for CTs, a TP report was reviewed 72.5% of the time. Oncs reported that TP saved time identifying potential CTs during 57.1% of the visits. The reports were manually reviewed, and the TP matching algorithm was 100% accurate. 90.9% of the oncs recommended TP for CT screening. Conclusions: These results indicate that Trial Prospector is a feasible, accurate, and effective means to identify CTs for individual pts during a busy outpatient oncology clinic. Ongoing refinements will expand clinical data extraction and CT warehouse to improve precision and applicability across diseases.
Cancer clinical trial accessibility in the United States: An analysis of travel distance.
Authors: Latif Asma , Stensland Kristian D , Hendricks Ryan , Moshier Erin L. , Godbold James H. , Oh William K. , Galsky Matt D. 
Published: March 2020

6540 Background: Accessibility of cancer clinical trials has been cited as a barrier to participation. While there are several dimensions to accessibility, travel distance may represent an important measure with potential socio-demographic implications. We sought to identify the driving distance from each ZIP-code in the United States to the nearest clinical trial site for four common solid tumors, and correlate ZIP-code level demographics with travel distance. Methods: The ClinicalTrials.gov database was queried on September 12, 2012 to identify all open, actively recruiting phase II and phase III therapeutic interventional trials in first-line metastatic disease for the four most common solid tumor types in the United States (prostate, breast, lung, and colorectal). Driving distance from each ZIP-code in the continental United States to the nearest trial site for each tumor type was calculated. Trial sites located within the ZIP-code were set at a travel distance of 0 miles. ZIP-code level demographics, derived from the 2010 Census, were correlated with driving distance. Results: We identified 42 prostate cancer trials with 958 sites, 81 breast cancer trials with 1,345 sites, 83 lung cancer trials with 2,249 sites, and 32 colorectal cancer trials with 566 sites which met inclusion criteria. The travel distances for each tumor type are shown in the Table. Analyses correlating driving distance with ZIP-code level demographics are ongoing. Conclusions: Substantial heterogeneity exists regarding accessibility of cancer trials in the United States as measured by driving distance. The optimal geographic distribution of trials, the burden imposed by travel, and the degree to which travel distance contributes to poor cancer clinical trial enrollment all warrant further investigation. [Table: see text]
Willingness of patients to provide biologic samples for pharmacogenomic testing.
Authors: Loo Tenneille T. , Cuffe Sinead , Hon Henrique , Martin Petra , Brown M Catherine , Alibhai Shabbir M.H. , Leighl Natasha B. , Mascaux Celine , Tsao Ming-Sound , Shepherd Frances A. , Qiu Xin , Xu Wei , Liu Geoffrey 
Published: March 2020

6543 Background: Additional biopsies and/or blood sampling (i.e.: germline and plasma markers, circulating DNA or tumour cells) may be necessary to complete pharmacogenomic testing (PGT) in some patients. Cancer patients’ perspectives on providing additional biospecimens are important in addressing potential knowledge translation barriers. Methods: 790 clinic patients from the Princess Margaret Cancer Centre (Toronto, Canada) were interviewed with a standardized questionnaire, representing a wide distribution of adult solid and hematological disease sites. Study endpoints included patient preferences and willingness to provide biological samples (new blood, new biopsy, or pre-existing tumor samples) on a 5-point Likert scale. Univariate and multivariate models were created using SAS 9.3. Results: Patients were 49% female; 77% Caucasian/12% Asian; median age 58 years; and 67% had completed high school. Median household income was evenly trichotomized at $50K and $100K. Despite 33% of the patients being uncomfortable with the level of their knowledge about PGT, 75% agreed that additional tests would be beneficial to their health. Patient willingness to provide new samples was 88% for blood and 53% for biopsy, and 27% preferred existing tumor samples to be used in lieu of additional sampling. Caucasians and those with the highest incomes were more agreeable to providing blood and/or biopsy samples, whereas non-Caucasians and low-income earners preferred utilization of existing tumor samples over additional blood sampling (p<0.05). Conclusions: Patients were more willing to provide a new blood sample than a biopsy sample for PGT. Despite the vast majority agreeing to the potential benefit of additional sampling, only half were willing to provide a new biopsy sample. Level of willingness was related to sociocultural and economic factors. Improved patient education and increased efforts to design blood-based markers may improve uptake of PGT.
Are there racial differences in colorectal cancer care timeliness among users of the Veterans Affairs Healthcare System?
Authors: Zullig Leah L. , Jackson George L. , Weinberger Morris , Provenzale Dawn T. , Reeve Bryce B. , Carpenter William Ruffin 
Published: March 2020

6555 Background: The Veterans Affairs (VA) healthcare system is the largest integrated healthcare system in the United States. While the quality of VA colorectal cancer (CRC) care is well chronicled, there is a paucity of literature describing racial differences in timeliness of VA CRC care. The objective of this analysis was to examine potential racial differences in CRC care timeliness. Methods: Data were from the VA External Peer Review Program (EPRP), a nationwide VA quality-monitoring program. Included patients must have been Caucasian or African American, diagnosed with non-metastatic CRC between 2003 and 2006, and received definitive CRC surgery. We examined 3 timeliness metrics – time from: 1) surgery to initiation of adjuvant chemotherapy (Stage II-III), 2) surgery to surveillance colonoscopy (Stage I-III), and 3) surgery to death (Stage I-III). Unadjusted analyses used Log-rank and Wilcoxon tests. Adjusted analyses used Cox proportional hazard models. Results: In adjusted Cox regression there were no racial differences in time to initiation of chemotherapy (HR 0.82, p=0.61) or surgery to death (HR 0.94, p=0.0.49). In adjusted Cox regression, Caucasian race was protective, with shorter time to first surveillance colonoscopy (HR 0.63, p=0.02). The median time to colonoscopy was 367 and 383 days for Caucasian and African American patients respectively. Conclusions: Caucasian patients receive follow-up colonoscopies slightly sooner than African American patients in VA; the difference between median times by race is only 16 days. Though statistically significant, this difference is not clinically meaningful since no scientific evidence suggests differing benefits of surveillance colonoscopy in a small timeframe.
Predictors of care for early-stage breast cancer in Appalachia.
Authors: Kimmick Gretchen Genevieve , Camacho Fabian , Kern Teresa , Fleming Steven , Liao Jason , Matthews Stephen , Hwang Wenke , Mackley Heath B. , Lipscomb Joseph , Short Pamela , Moran John , Yao Nengliang , Anderson Roger T. 
Published: March 2020

6558 Background: We studied care for early-stage breast cancer in Appalachia, a region with health infrastructure, socioeconomic (SES) and geographic disparities. Methods: Cases of stage I-III breast cancer diagnosed 2006-2008 were identified from cancer registries of KY, NC, OH, and PA and linked to Medicare data. Guideline concordance was studied in eligible groups, as follows: endocrine therapy for hormone receptor positive cancer (n=1429); and radiation (RT) use after breast conserving surgery (BCS) divided into two groups - age 70 years and older with ER/PR+, <2 cm, node negative tumors where it may have been acceptable to forgo RT (OptRT, n=1108) and all other cases (IndRT, n=1422). Multivariate (MV) and univariate analyses were performed. Covariates included age, state, Appalachian Regional Commission (ARC) economic status, Commission of Cancer (CoC) status, state, access to care, number of beds, surgery facility ownership, volume, and chemotherapy/radiation offered, provider graduation year and volume, Charlson comorbidity, diagnosis year, Medicaid/Medicare dual status, histology, tumor size, tumor sequence, positive lymph nodes, ER/PR status, stage, herceptin use, and BCS/mastectomy indicator. Results: Mean age was 74 years and 97% were white. Guideline-concordance was 76% for endocrine therapy, 83% for IndRT, and 77% for OptRT. Younger age predicted higher concordance in all groups. Endocrine therapy use was lower in NC vs PA (OR 0.60; 95% CI 0.41-0.88) and greater for cases whose provider graduated in years 1984-1988, vs. 1989+ (1.55; 1.06-2.29). In IndRT, provider volume in the 3rdquartile vs. highest quartile predicted increased radiation use (2.36; 1.46-3.81). In OptRT, less receipt of radiation was predicted by residence in NC vs. PA (0.26; 0.18-0.48), and competitive ARC class vs. transitional (0.60; 0.36-0.99). Conclusions: Within Appalachia, there are SES and provider characteristics that are associated with use of guideline concordant care.
Cultural competency training for health care providers in an urban cancer institute and impact on breast care.
Authors: Williams Erica H. , Whitaker Earlene , Zickafoose Barbara , Mete Mihriye , Swain Sandra M. 
Published: March 2020

6561 Background: The purpose was to improve the cultural competence of healthcare providers at an urban cancer institute and to assess its impact on breast screening and diagnostic benchmarks. Methods: A web-based learning module was developed to address breast cancer disparities in African American women, identifying common barriers to care and highlighting functions of patient-provider education. The module, a pre-and post-test were administered to providers including physicians, nurses, non-clinical employees, diagnostic technicians and medical office assistants (MOA) of MedStar’s Washington Cancer Institute (WCI) and Breast Imaging Center (BIC). Cultural competency discussions began with providers in BIC in April 2011. The module was available to BIC providers in October 2011 and to WCI providers in December 2011. To increase the cancer knowledge-base, a breast education class was offered to 40 MOAs. Statistical analysis was conducted using SAS v.9.1. Results: October 2011-March 2012, 133 providers were offered the module. Seven providers helped create the module, were removed from analyses. Of the 126, 29 did not complete all parts or complete in proper order and were not used in analyses. Overall, providers (n=97) demonstrated an increase in average pre/post test scores (119 vs. 123; P<.01). All providers, except diagnostic technicians, increased cultural competency scores post module. Physician’s average pre/post test scores showed the greatest increase with 11 points (P<.01). From Nov 2011- April 2012, BIC experienced a 59% decrease in number of patients lost to follow up after a screening mammogram, a 11% decrease in lost to follow up for diagnostic patients as well as a decrease of 1 days in average number of days patients return for diagnostic imaging after a mammogram. There was a 32% increase in employee satisfaction within in BIC. Conclusions: This suggests that our learning module had a positive impact on patient-provider communication. The decrease in screening and diagnostic lost to follow up rates illustrates the learning module’s potential for staff motivation in reducing breast cancer disparities. Supported by Susan G. Komen for the Cure NR-11-33340.
Current status of the implementation of gene expression testing in breast cancer management in the United States.
Authors: Lynch Julie Ann , Fiore Louis , Kelley Michael J. , Borzecki Ann , Lathan Christopher S. , Hassett Michael , Rugo Hope S. , Khoury Muin J , Freedman Andrew N 
Published: March 2020

6562 Background: Data on implementation of genetic diagnostic (GDx) tests are lacking yet are crucial to evaluate population differences in access and outcomes. Previous studies identified substantial underuse of GDx tests. Greater access existed in states with NCI cancer centers. This pattern of diffusion may exacerbate disparities. Since 2008, the 21-gene recurrence score (21-gene RS), which assesses the 10-year risk of breast cancer (BC) recurrence in ER+, node-negative, early-stage disease, has been recommended by ASCO/NCCN to guide chemotherapy decisions. This study examines regional and site-of-care differences in use. We report national implementation rate and state-level differences in utilization. Methods: Hospital level data on 2011 orders for the test were provided by Genomic Health. We aggregated this dataset at the state-level and linked it to public datasets (Census and CDC State Cancer Profiles). Using Surveillance Epidemiology End Results (SEER) data, we estimated number of guideline-directed BC cases. The outcome variable, state utilization ratio, was calculated by dividing the number of tests ordered by guideline-directed BC cases. For some states utilization ratios may be higher than 1 because patients may have crossed state boundaries to obtain care. Results: Of approximately 101,702 guideline-directed BC cases nationally, 59,053 patients had the test; a utilization ratio of 0.58. Utilization ratio by state ranged from 0.21 to 1.71 (25th/75thpercentile range 0.48-0.64). The District of Columbia had the highest utilization ratio at 1.71 (8 institutions ordered 367 tests on an estimated 213 patients); Iowa had the lowest at 0.21 (39 institutions, 458 tests, 2094 patients). Only 7 states had utilization ratios <0.45. Conclusions: In contrast to other GDx tests, 21-gene RS has achieved notable market penetration. Overall, utilization across states is remarkably consistent, especially considering potential variations in age, comorbidities, stage, and incidence of ER+ BC. Despite widespread use, there are likely county-level and site-of-care differences in use. Hospital level analysis is ongoing and will be presented at the meeting.
Cancer risks, beliefs, and health care access among the underprivileged.
Authors: Morere Jean F. , Viguier Jérôme , Pivot Xavier B. , Blay Jean-Yves , Coscas Yvan , Lhomel Christine , Eisinger François 
Published: March 2020

6563 Background: One goal of the current French National Cancer Plan is to reduce health inequities in cancer control. In the present work, an underprivileged population was explored to analyze exposure to cancer risk factors and cancer screening attendance in order to highlight ways to improve cancer control. Methods: Within the nationwide observational study EDIFICE 3, conducted by phone interviews among a representative sample of 1603 subjects aged between 40 and 75 years old, we used the “EPICES” validated questionnaire to examine the association of underserved status with cancer risk factors, beliefs, and health care access. Results: Based on EPICES score, underserved subjects represent 33% of the sample. These subjects subjectively perceive a higher risk of cancer compared to non-underserved subjects (21% vs 14% respectively, p<0.01). They more often consider that the cancer always has an external cause (18% vs 12%, p<0.01), rely less on information from the general practitioner (48% vs 56%, p<0.01) and lay press (28% vs 37%, p<0.05). They trust the national health system less (average score from 1 to 10; 6.0 vs 6.3, p <0.05). They also have more cancer risk factors: BMI (26.0 vs 24.8, p<0.01), active smoking (38% vs 23%, p<0.01) and less practicing sport (42% vs 77%, p<0.01). They have more comorbidities: average (2.2 vs 1.8, p<0.01), at least one (76% vs 65%, p<0.01), anxiety (27% vs 12%, p<0.01), hypertension (24% vs 19%, p<0.05) and cardiovascular disease (13% vs 9%, p<0.05). Among persons with a cancer, underserved subjects have a higher rate of lung cancer (10% of cancers vs 1%, p<0.05). However, no difference in cancer screening attendance was observed between underserved and non-underserved subjects: colorectal cancer (60% vs 60%); breast cancer (94% vs 97%) and prostate cancer (46% vs 52%). Access to healthcare is not an issue (consultations with a general practitioner more frequent for underserved group: 5.4 vs 3.7 per year, p<0.01). Conclusions: To reduce inequities in cancer control, as screening attendance is not discriminating, the effort for upstream interventions should be focused on prevention. Cancer risk factors such as smoking, overweight and a sedentary life style are appropriate targets for communication campaigns.
Minority accrual on a prospective study targeting a diverse U.S. breast cancer population: An analysis of Wake Forest CCOP research base protocol 97609.
Authors: Urbanic James John , Case Doug , Naughton Michelle Joy , Hu Jennifer J. , Enevold Gina , Beech Bettina , Weaver Kathryn E , Danhauer Suzanne , Rapp Steve , Sheidler Vivian , Vitolins Mara , Lesser Glenn , Shaw Edward G. 
Published: March 2020

6564 Background: Clinical trial accrual rates are lower among minority patients. Wake Forest CCOP RB protocol 97609 designed to accrue 400 non-Hispanic White (NHW) and 600 minority patients to a study evaluating potential genomic single nucleotide polymorphisms as markers for breast radiosensitivty. Methods: Accrual data evaluated from 24 participating CCOPs and numerous CTSU sites. Race / ethnicity self-reported by participants (NHW, non-Hispanic Black, Hispanic/Latino, Asian /Pacific Islander, or American Indian/Alaskan Native) based on ACS reporting criteria. Results: 752 participants accrued in 14.5 mths (11/11-1/13); 402 NHW and 350 minorities. NHW accrual goal reached, 5.9 months (period 1; avg 68.4 participants /month) compared with 54 minority participants (period 1; avg 9.2 participants / month). This 7.4 ratio NHW to minority accrual is higher than expected given incidence. During 8.6 months following closure NHW enrollment (period 2), 296 minority participants accrued (avg 34.3 participants/month). An almost 4-fold increase in minority accrual raises question of accrual disparity. 19 CCOPs open in period 1 and 24 CCOPs in period 2. CTSU contributed both periods, more CTSU sites were added during period 2. Excluding all CTSU sites and five CCOPs open only in period 2, the avg minority accrual:6.8 patients / month period 1 and 10.6 patients / month period 2. The average time of accrual was 4.0 months period 1 and 8.6 months period 2 due to variable opening dates at sites. Taking time into account, the avg minority accrual rate was 0.60 patients / month / site in period 1 and 0.56 patients / site / month in period 2. CCOP minority accrual rates in period 1 vs. 2 increased 11 / 19 sites, decreased 6 / 19, and remained the same in 2 / 19, p = .33. Conclusions: Despite closure of enrollment of NHWs into this study with a specific goal to accrue a large minority population, there was no increase in the rate of minority accrual. The initial appearance of an accrual bias can be attributed to the addition of sites and variable lengths of accrual time at sites. It is unknown whether overall lower minority accrual rate compared to NHWs is participant-, provider-, or population-based. Clinical trial information: NCT01407770.