bluuebunny/crossref_metadata_2025_split huggingface dataset:
A cross-sectional study on global disparities in information experiences of patients with lymphoma/CLL.
Authors: Bamigbola Olufunmilayo , Dren Natalie , Warwick Lorna 
Published: June 2021

e18517 Background: Patient-centricity remains a cornerstone in the care of patients with lymphoma and CLL, as informed patients are consistently associated with better outcomes and experiences. This study uses the Lymphoma Coalition (LC) 2020 Global Patient Survey (GPS) on Lymphomas and CLL to describe the global differences in the top choices for medical information among patients with lymphoma, as well as differences in their understanding of this information relating to various aspects of their care. Methods: Globally, 9,179 patients from 89 countries took part in the LC 2020 GPS. The countries were grouped into regions, and the regions with greater than 200 patients were included in the analysis (Table). The demographics of the regions were examined, and descriptive analyses of questions relating to information source preferences, information provision at diagnosis (addressing treatment options; process and stages of care; managing treatment side effects), and corresponding levels of patient understanding were performed in IBM SPSS v27. Results: Doctors were the first choice for medical information for patients in each region (SA-82%, AS- 75%, EU-69%, OC-63%, NA-61%). In EU, NA and SA, websites were the most prevalent second and third choice for information (27% and 28%; 30% and 32%; 35% and 27%, respectively). In AS, patient advocacy organisations were the most prevalent second and third choices for information (32% and 40%, respectively), while in OC, the most prevalent second and third choices were nurses (27%) and patient advocacy groups (32%) respectively. Over a fifth of NA patients were not given information on the process and stages of care and how to manage side effects of treatment (21% and 29%, respectively). About a third of patients from SA (32%) reported not getting information on treatment options. Over half of OC patients reported being given information on and completely understanding the different treatment options (51%), processes and stages of care (53%) and how to manage treatment side-effects (58%). Patients from AS were the most prevalent in reporting across the three categories, that they were given information but did not understand it (10%, 7%, 5%, respectively). Conclusions: Globally, patients with lymphoma use various avenues to source the medical information they need, and they differ in their information experiences. Access to appropriate and adequate medical information remains an essential aspect of a successful patient experience and LC advocates that this information be contextual and accessible to all patients with lymphoma. [Table: see text]
A trial-level correlation analysis of progression-free survival as a surrogate for overall survival in the immunotherapy era.
Authors: Yekeduz Emre , Koksoy Elif Berna , Akbulut Hakan , Utkan Gungor , Urun Yuksel 
Published: June 2021

e18580 Background: Progression-free survival (PFS) is accepted as a surrogate endpoint for cancer drugs approval by the Food and Drug Association. In the expanding immunotherapy era, there is no convincing data for reliable surrogacy of PFS. Methods: We systematically searched PubMed and included all phase III trials of ICIs. Besides, we manually included phase III trials of ICIs presented in congresses. Trials including non-metastatic patients and hematologic malignancies were excluded. The primary endpoint was the relationship between treatment effects (i.e., hazard ratio (HR) of PFS and overall survival (OS)). The secondary endpoint was the relationship between the median PFS (mPFS) and median OS (mOS). We also performed subgroup analyses by ICIs subtypes (i.e., anti-programmed death-1 (PD-1) and anti-programmed death ligand-1 (PD-L1)), treatment lines (i.e., the first-line and subsequent treatments), ICI plus CT combination, and ICI monotherapy. To ensure parametric assumptions, we addressed logarithmic conversion to HRs by using log10. We used Pearson’s correlationand weighted linear regression for parametric variables and Spearman’s rank-order correlation for non-parametric variables. We assessed the relationship between variables by using correlation coefficient (r) and coefficient of determination (R2). Results: We included 57 phase III clinical trials with 39,525 patients. A total of 67 outcomes were compared. There was a good correlation between the logarithmic HR of PFS (log HRPFS) and OS (log HROS) (r=0.71, R2=0.50 p<0.001). In subgroup analyses, there was a weak or moderate correlation between the log HRPFS and log HROS in anti-PD-L1, ICI plus CT, and the first-line treatment subgroups (r=0.61, R2=0.38 p=0.004 for anti-PD-L1; r=0.65, R2=0.43 p=0.008 for ICI plus CT; r=0.70, R2=0.49 p<0.001 for the first-line treatment). Conversely, there was a good correlation between the log HRPFS and log HROS in the anti-PD-1, ICI monotherapy, and subsequent treatment line subgroups (r=0.81, R2=0.66 p<0.001 for anti-PD-1; r=0.71, R2=0.51 p<0.001 for ICI monotherapy; r=0.78, R2=0.62 p<0.001 for subsequent treatment line). Correlations between the mPFS and mOS were good or strong in all subgroups. (Table). Conclusions: PFS might be considered a reliable surrogate endpoint for OS, particularly in anti-PD-1 ICIs, ICI monotherapy, and subsequent metastatic cancer treatment lines.[Table: see text]
In-hospital outcomes of transcatheter aortic valve replacement (TAVR) in patients with localized and metastatic malignancy.
Authors: Macchi Hugo , Salazar Miguel , Del Cid Fratti Juan , Gauto Estefania , Baral Binav , Shrivastava Trilok , Upadhyay Banskota Shristi Upadhyay , Zia Maryam , Khanal Nabin 
Published: June 2021

e18602 Background: There is limited use of transcatheter aortic valve replacement (TAVR) in patients with malignancy, given that current guidelines do not recommend TAVR in patients with a life expectancy of less than 1 year. Data that compare short-term outcomes after TAVR in cancer and metastasis is scarce. Methods: Using the national inpatient sample (NIS) database, we identified patients who underwent TAVR from 2016-2017 using ICD10-PCS codes. Patients were subsequently divided based on local malignancy and metastatic malignancy. In-hospital mortality, total hospital cost, length of hospital stays, and post-procedural complications were evaluated. Multivariate logistic regression analysis was conducted to adjust for confounders. Results: A total of 91, 624 TAVR hospitalizations were identified, 4, 995 (4.7%) with malignancy. Patients with malignancy were most likely to be women, have a higher Charlson comorbidity index, to use private insurance, and being admitted to a teaching hospital. The most common malignancy was hematological, head and neck, prostate, digestive, and breast cancer of these patients 15.6% had metastatic disease at the time of TAVR. After adjusting for confounders there was no difference in mortality, LOS, healthcare utilization, and post-procedural complications. Conclusions: TAVR seems to have a safe short-term outcome in patients with active malignancy and metastatic disease. In this population, we recommend having an oncological evaluation to perform a risk assessment to aid in the decision when to not proceed with TAVR.[Table: see text]
How to choose your surgeon for colorectal cancer: The influence of fellowship training on outcomes.
Authors: Aquina Christopher Thomas , Becerra Adan Z. , Ejaz Aslam , Monson John R.T. , Fleming Fergal J. 
Published: June 2021

e18603 Background: Rectal cancer has a well-established volume-outcome relationship. However, the impact of fellowship training on outcomes following colorectal cancer resection is unknown. Methods: Patients who underwent stage I-III colorectal adenocarcinoma resection (2004-2014) were identified in the New York State Cancer Registry and Statewide Planning & Research Cooperative System. Hierarchical analyses assessed the association between surgeon American Board of Colorectal Surgery (ABCRS) certification and postoperative outcomes and survival. Derived from volume tertiles, surgeons who performed ≥15 annual colon cancer resections or ≥10 annual rectal cancer resections were characterized as high-volume colon (HVCSs) or rectal (HVRSs) surgeons, respectively. Results: 47,491 colorectal cancer resections (right colon = 23,824, 50.2%; left colon = 18,154, 38.2%; rectal cancer = 5,513, 11.6%) met inclusion criteria. ABCRS-certified HVCSs (N = 92) comprised only 5.5% of the surgeon cohort but performed 20.6% of the colon cancer resections. Similarly, ABCRS-certified HVRSs (N = 31) comprised only 3.8% of the surgeon cohort but performed 16.5% of the rectal cancer resections. Despite no significant difference in complications, ABCRS-certified HVCS/HVRSs overall had better postoperative outcomes and were associated with improved survival following colorectal cancer resection. Conclusions: These results suggest that for the best outcomes and long-term survival following colon and rectal cancer resection, referral to high-volume, ABCRS-certified surgeons may be the best choice.[Table: see text]
Outcomes with COVID-19 in patients with hematopoietic stem cell transplant and cellular therapy: A systemic review and meta-analysis.
Authors: Chaudhary Sibgha Gull , Zafar Muhammad Usman , Hassan Maha Awaiz , Shahzad Moazzam , Hussain Ali , Ali Fatima , Riaz Yumna , Khalid Fatima , Khurana Sharad , Balusu Ramesh , Ahmed Nausheen , Singh Anurag K , Anwer Faiz , Abhyankar Sunil H. , McGuirk Joseph , Mushtaq Muhammad Umair 
Published: June 2021

e18611 Background: Coronavirus Disease 2019 (COVID-19) was declared a pandemic on March 11, 2020. COVID-19 has caused over 100 million infections and over 2 million deaths globally. Patients who have received a hematogenic stem cell transplant or cellular therapy (HCT) have a high risk of mortality and morbidity with COVID-19 due to severe immune dysregulation. We conducted a systematic review and meta-analysis aimed to evaluate the outcomes of COVID-19 in HCT patients. Methods: A literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA) guidelines was performed on 3 databases (PubMed, Cochrane, and Clinical trials.gov) from the date of inception to Jan 2021. MeSH terms included ‘hematological malignancies’, ‘hematopoietic stem cell transplantation’, ‘SARS-CoV-2’, and ‘COVID 19’. We screened 99 articles and 6 studies (4 retrospective studies, 2 prospective) were included after excluding review, duplicate, and non-relevant articles. Quality evaluation was done using the NIH quality assessment tool. The Inter-study heterogeneity among the studies was assessed using the Q statistic proposed by Cochrane and the I2 index introduced by Higgins and Thompson. Pooled analysis was done using the ‘metaXL’, and the random effects model was used to estimate the pooled prevalence with 95% CI. Results: Of 1619 patients in 6studies, 646 HCT patients were analyzed (Table ). The median age of patients was 63 years and 59% were males. Median days since HCT for autologous (auto) HCT and allogeneic (allo) HCT patients were 690 and 450 days respectively. The average follow-up duration after COVID-19 was 24 days. COVID-19 mortality in HCT patients was 20% (95%CI 0.17 to 0.23, I2=0). Roedl et al (n=6) reported a mortality of 83% and was excluded from the pooled analysis. The mortality rate was 19% (95% CI 0.15 to 0.24, I2=0%) in auto HCT patients and 21% (95% CI 0.17 to 0.25, I2=0%) in allo HCT patients. Conclusions: The HCT patients are at significant risk of increased mortality and morbidity due to COVID-19. There is a need to prioritize HCT patients for COVID-19 vaccination, close surveillance, and aggressive management.[Table: see text]
Patient-reported outcomes in clinical trials for multiple myeloma: Where we are.
Authors: Andreas Marike , Salek Sam , Kreuzberger Nina , Piechotta Vanessa , Oliva Esther Natalie , Ionova Tatyana , Monsef Ina , Skoetz Nicole , Laane Edward 
Published: June 2021

e18615 Background: It is recommended to include patient-reported outcomes (PROs) in cancer trials to ensure clinical benefit based on patients’ perceptions. For multiple myeloma patients, PRO measurement is essential to understand the impact of treatment on their physical and psychosocial functional behaviour. However, it is unclear which PRO instruments are utilized in multiple myeloma trials, how often they are used and whether results are consistently reported. The aim of this project was to explore the use and frequency of PRO instruments in randomized controlled trials for multiple myeloma and to assess the consistency of their reporting. Methods: Within the European Hematology Association (EHA) project to develop guidelines for the use of PROs in adult patients with hematological malignancies, MEDLINE and CENTRAL were systematically searched for randomized controlled trials investigating multiple myeloma between 2015 and 2020. Study design, disease and treatment characteristics, the primary outcome and used PRO instrument(s) were extracted using a pre-defined template. To assess the consistency of PRO reporting, study registries were compared with publications, study protocol and Health Technology Assessment (HTA) reports where available. Results: Overall, 10,707 records were found. Following screening for randomized-controlled trials, 283 ongoing, completed or published studies were included for review. 118 studies planned the use of PROs. The most frequently used PRO instrument (92 studies) was the EORTC QLQ-30, an instrument that measures health-related quality-of-life (HRQoL) in cancer patients. The disease-specific questionnaire EORTC-MY20 was also frequently used (50 studies). Likewise, the HRQoL instrument EQ-5D was used in 50 studies. Overall, 38 different PRO instruments were reported. In 39 studies for which a study protocol was found, only 19 reported PRO instruments consistently with the trial registry for the study. In addition, in 30 studies, for which a publication reported PRO results (58 overall), the information on PRO instruments differed between publication and the trial registry. For example, PRO instruments mentioned in the registry were omitted in the respective publications. Additionally, information on PRO in HTA reports was available for 26 studies, of which 18 reports were consistent with the trial registries. Conclusions: The results show that measurement of PROs still remain under-utilized in multiple myeloma research. While most PRO instruments identified in this review comply with the recommendations for incorporating PROs into clinical research in adult oncology, they are often inconsistently reported. Thus, reporting standards for the use of PROs are needed to ensure consistency in the use and reporting of PROs.
Characterizing unplanned resource utilization associated with cancer-related diarrhea.
Authors: Schwartzberg Lee S. , Roeland Eric , Okhuysen Pablo C. , Anupindi Ruthwik , Hull M , Yeaw Jason , Sun Lucille , Tam Iris M. , Franklin Gina , Chaturvedi Pravin 
Published: June 2021

e18625 Background: In clinical oncology practice, diarrhea is a very common and severe side effect of cancer treatments including from radiotherapy, chemotherapy, and targeted therapies. Cancer-related diarrhea (CRD) leads to increased healthcare resource consumption due to unscheduled outpatient visits, and , increased hospital stays requiring intensive supportive care measures. We evaluated CRD patients receiving chemotherapy, targeted therapy, or both, requiring emergency department (ED), physician office visits, hospitalizations, and length of stay (LOS) compared to a matched cohort of non-CRD patients. Methods: We performed a longitudinal study among adult patients ( > 18 yrs) with CRD identified by diagnosis codes or pharmacy claims compared to matched non-CRD patients using claims data derived from the IQVIA PharMetrics Plus database. Index date was the first cancer claim date and patients were re-indexed based on their CRD claim. Each patient had a 6-month pre-index period, a minimum 3-month post-index period and had ≥12 months of continuous enrollment following the CRD index date. To adjust for selection bias and baseline differences, we matched CRD patients to non-CRD patients (1:1) by age, gender, geography and payer type. Patients were stratified by cancer therapy type (chemotherapy, targeted therapy or both treatments). We reported proportion of patients with hospitalizations, average length of stay (LOS), and ED visits. A generalized estimating equation model with log link and binomial distribution adjusted for type of cancer, therapy, and Charlson Comorbidity Index (CCI) was built to estimate the difference in occurrence of hospitalization between CRD and non-CRD cohorts. Results: We evaluated a total of 104,135 matched pairs of CRD and non-CRD adult patients with solid or hematologic cancer with 12-month continuous enrollment. The proportion of patients with ED visits (36.2% vs 18.9%, p < 0.0001) and hospitalizations (29.6% vs 12.8%, p < 0.0001) were significantly higher among CRD versus non-CRD cohort. When compared to non-CRD patients, CRD patients were more likely to be hospitalized (adjusted OR 2.28. 95% CI of 2.23-2.33). Mean CRD-specific office/hospital visits were significantly higher in the CRD cohort compared to the non-CRD cohort over the 12-month post-index period and patients had more CRD-specific visits to ED (7.5% vs 1.8%); physician’s offices (14.7% vs 3.8%); laboratory testing (11.6% vs 3.2%) and outpatient ancillary services (10.9% vs 2.6%) (all p < 0.0001). Mean hospital LOS among patients with CRD was higher than non-CRD patients (6.6±8.9 vs 5.8±10.5 days, p < 0.0001). Conclusions: Patients with CRD used significantly more resources, including outpatient services, ED visits, and hospitalizations. Effective prevention of CRD remains an unmet strategy to reduce the overall cost of cancer care.
Can online patient reviews be used to assess oncologist competency? RateMD as a cancer care evaluation tool.
Authors: Morena Nina , Zelt Nicholas , Nguyen Diana , Rentschler Carrie A. , Greyson Devon , Meguerditchian Ari N. 
Published: June 2021

e18656 Background: Medical oncology (MEDONC) requires a combination of skills in collaboration, communication, and professionalism, ultimately delivering technical and clinical knowledge in practice. Standard assessment tools (e.g. written examination, OSCE) are not effective in evaluating competencies beyond technical skills and fail to define the cancer care experience holistically. This explorative, descriptive study aims to identify the potential of unstructured, unsolicited, open access online patient reviews (OPRs) as a tool to assess physician competency. Methods: University-affiliated MEDONCs in Ontario (Canada) were selected. All OPRs were identified on RateMD using every name permutation; physician names and institutional affiliations were removed from comments. A descriptive analysis of the cohort was completed. The CanMEDS Framework, defining physician standards, was used with its hierarchy of roles, concepts, and competencies. Two reviewers, a communication studies researcher and a healthcare professional, independently assessed comments and identified common themes. Competency-level assessments were evaluated using kappa with linear weights. Results: 473 OPRs were identified for 49 MEDONCs (71% male, 29% female). Of these, 23% were written by care providers. Competencies defining roles of Medical Expert, Communicator, and Professional were most prevalent (64%, 38%, and 27% respectively). Agreement levels were high in all roles (wK = 0.71 - 1.00). Themes identified were similar in positive and negative evaluations. Most commonly discussed positive themes were knowledge translation and compassionate interpersonal skills. Most common negative themes centered on lack of humility, compassion, and communication skills. 38% of comments were marked helpful, indicating engagement with other OPRs as a key characteristic of rating tools. In addition to the physician in question, 21% of OPRs reported on healthcare delivery by staff. Conclusions: OPRs emphasize experiential competencies related to interpersonal skills and suggest an alternative format to evaluating such aspects of MEDONC competencies.[Table: see text]
Multi-level QI interventions in a safety-net academic oncology clinic.
Authors: Jotwani Aparna Chakravarti , Miller-Chism Courtney Nicole , Crawford Margaret Griffin , Mach Claire , Woods LaToya , Zhang Jessica , Godwin Kyler , Murphy Daniel 
Published: June 2021

e18665 Background: Clinic cycle time is a performance metric and prolonged wait times may impact patient satisfaction and/or treatment outcomes. In primary care clinics, studies show prolonged cycle times detract from patient satisfaction. Fewer studies examine specialty clinics such as oncology which require multi-faceted care. Our Harris Health System (HHS) serves a diverse county with high patient volume with physician learners and limited providers due to limited resources. Our patient satisfaction assessments previously identified prolonged wait times as an area for improvement. Our team studied and process mapped operations with the goal of improving clinic efficiency. Our primary objective is to streamline the process for our outpatient oncology appointments measured through patient cycle times. We aimed to decrease the cycle time by 25% and improve patient satisfaction. Methods: From January 2018 through December 2019, the cycle time processes for Smith Thursday Oncology Clinics in the HHS were mapped and analyzed, and sequential PDSA (Plan-Do-Study-Act) cycles were completed to reduce non-value-added time. Six-month cycle times before and after implementation of three process changes implemented were compared with t-test analysis. Next, NRC (National Research Corporation) Health patient satisfaction data for the corresponding time frames was compared with both t-test and chi-square analyses. Results: Patient cycle time from July 2018 – December 2018 was compared to July 2019 – December 2019 with a t-test analysis. Our results showed a significant (p = 0.036) reduction in cycle time. The average percent decrease in cycle time was 19%. NRC patient satisfaction data inquiries, including overall satisfaction, informed regarding appointment delays, and waiting for more than 15 minutes were reviewed for this same time frame. We found trends in all three categories showing improvements in scores with p-values of 0.483, 0.821 and 0.282 respectively. Conclusions: Through multi-level interventions we were able to significantly reduce clinic cycle times. Trends towards improvement were seen as the population assessed was in the hundreds and not thousands needed for significance. Our academic teaching model is meaningful to study as it serves a high patient volume and educates future oncologists, especially pertinent when a shortage of oncologists in anticipated in the future. Additionally, our patients receive high quality care with nursing, education and infusion services. An area for improvement is communication with patients during their cycle times and other early QI work in our clinics show patients are interested in further education. Our underserved patient population is multi-ethnic, has unassessed health literacy, and frequent language barriers. Better efficiency in the clinics and utilization of cycle time can have multiple patient benefits that warrant further work in QI.