bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of ECOG performance status on recurrent/metastatic head and neck squamous cell carcinomas treated with anti-PD1 inhibitors.
Authors: Chalker Cameron , Wu Vicky , Voutsinas Jenna M. , Hwang Victoria , Baik Christina S , Liao Jay Justin , Lee Sylvia , Futran Neal D. , Houlton Jeffrey , Barber Brittany , Parvathaneni Upendra , Laramore George E. , Santana-Davila Rafael , Eaton Keith D. , Martins Renato G. , Rodriguez Cristina P. 
Published: June 2021

e18004 Background: Anti-PD1 checkpoint inhibitors (ICI) represent an established standard of care for patients with recurrent/metastatic head & neck squamous cell carcinoma (RMHNSCC). Landmark studies excluded patients with ECOG performance status (PS) ≥ 2; the benefit of ICI in this population is therefore unknown. Methods: We retrospectively reviewed RMHNSCC patients who received at least 1 dose of ICI at our institution. Demographic data and clinical outcomes were obtained; the latter included objective response to ICI (ORR), physician-documented CTCAE grade 2+ toxicity (irAE), and any unplanned hospitalization within 100-days of last ICI dose (UH). Associations between demographic data and clinical outcomes were explored using both uni- and multivariate analysis. Overall survival (OS) was estimated using a Cox proportional hazards model; ORR, irAE, and UH were evaluated with logistic regression. This project was approved by our institutional IRB. Results: We identified 152 RMHNSCC patients who were treated with ICI between 1/2013 and 1/2019. ECOG PS was 0 in 42 (27%), 1 in 75 (50%), 2 in 27 (18%), 3 in 2 (1%), and unknown in 6 (4%) patients. The median age was 61 (range: 25 - 90). 124 (82%) were male, 124 (82%) were white, and 69 (45%) were never-smokers. The most common primary sites were the oropharynx (n = 59, 40%), oral cavity (n = 39, 26%), nasopharynx (n = 11, 7%), and larynx (n = 10, 6%). 54 (36%) were p16+ oropharynx cancers. CPS score was available in 10 (6.6%). Single agent ICI was received by 118 (77%) patients. 66 (44%) had a documented irAE and 54 (36%) had an UH. A multivariate model for OS containing PS, smoking status and HPV status showed a strong association between inferior OS and ECOG 2/3 compared to 0/1 (p < 0.001; HR = 3.30, CI = 2.01-5.41), as well as former (vs. never) smoking status (p < 0.001; HR = 2.17, CI = 1.41-3.35). Current smoking (p = 0.25) did not reach statistical significance. On univariate analysis, poor PS was associated with inferior ORR (p = 0.03; OR = 0.25, CI = 0.06-0.77) and increased UH (p = 0.04; OR = 2.43, CI = 1.05—5.71). There was no significant association between irAE and any patient characteristic. Conclusions: We observed inferior overall survival among ICI-treated RMHNSCC patients with ECOG 2/3 in our single-institution, retrospective series. Our findings help frame discussion of therapeutic options in this poor-risk population. Further study must be done to determine which interventions are of greatest benefit for RMHNSCC patients with declining performance status.
Analysis of outcomes and disposition in hospitalized patients with head and neck cancer over 15 years.
Authors: Guddati Achuta Kumar , Komiya Takefumi 
Published: June 2021

e18021 Background: The care of hospitalized head and neck cancer patients often involves a multidisciplinary approach. The trends, outcomes and disposition in hospitalized patients with head and neck cancer in United States for the past two decades has not been well characterized. This retrospective study involves analysis of the demographics, outcomes and disposition of these patients and their trend over 15 years. The presence of medical comorbidities and the relationship to inpatient mortality was also studied. Methods: Hospitalization data from the National Inpatient Sample database was analyzed for the years: 2000 to 2014. Patients with head and neck cancer were identified using ICD-9 codes. Demographic features such as age, gender, race, geographical location, hospital size, hospital location, insurance etc. were analyzed. The trend of mortality was analyzed for the study period of 15 years. A sub-analysis of associated comorbidities was also performed in patients who have died during hospitalization. Univariate analysis was initially performed followed by multivariate analysis and logistic regression to identify risk factors associated with mortality. Results: An estimated 145,262 hospitalizations involving patients with head and neck cancer from 2000 to 2014 were studied and it showed a gradual yearly increment in hospitalization. 41% of the hospitalizations were in the 50-64 years age group. There was a 2:1 male preponderance. Caucasians constituted 60% followed by African Americans at 10%. A majority of the hospitalizations occurred in large sized hospitals and urban teaching hospitals. The mean length of stay was 6.4 days but 38% of the hospitalizations involving 2-5 days of stay. The inpatient mortality rate was 4.6% and it down trended over the past 15 years with statistical significance (p < 0.05). Inpatient mortality was highest in the > 80 years age group. Of note, inpatient mortality was equal between both the genders. Mortality was highest in the groups with a length of stay below 2 days and above 11 days. 58% of the discharges did not need any special services while 21% of the discharges involved home health care. The most common comorbidities were smoking and hypertension while < 1% of morbid obesity was observed. Multivariate analysis showed malnutrition, ESRD, cirrhosis, stroke and CHF were significant risk factors (ORs: 1.6, 1.94, 2.18, 2.2 and 1.78 respectively). Conclusions: Mortality in hospitalized patients with head and neck cancer has improved over the past 15 years. Inpatient mortality was high in the very elderly and in female patients (compared to the male preponderance upon admission). Malnutrition, cardiac/liver/renal dysfunction and stroke were significant risk factors for inpatient mortality. Strategies to mitigate inpatient mortality in these patients need to factor the above risk factors during their in-hospital management.
Survival outcomes in primary angiosarcoma of the head and neck: A systematic review and meta-analysis.
Authors: Zayed Sondos , Lin Cindy , Boldt Gabriel , Lang Pencilla , Read Nancy , Venkatesan Varagur , Sathya Jinka , Kevin Fung , MacNeil Danielle , Mendez Adrian , Yoo John , Warner Andrew , Nichols Anthony C. , Palma David A. 
Published: June 2021

e18039 Background: Angiosarcoma of the head and neck (ASHN) is a rare entity and confers substantial morbidity and mortality. Yet, the optimal management of ASHN remains unclear. This study aimed to describe the epidemiology of ASHN and to identify the most favorable treatment approach. Methods: We performed a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, using the PubMed (Medline), EMBASE, and Cochrane Library databases, queried from 1990 until present. Articles in the English language reporting on survival outcomes of adult primary ASHN treated with curative-intent, were included. All estimates were weighted based on sample size. Analysis of variance (ANOVA) and two-sample t-tests were used as appropriate. This study was registered with PROSPERO, CRD42021220970. Results: A total of 3652 studies were identified, with 14 articles reporting on 2265 ASHN patients, meeting inclusion criteria. Mean ± SD age was 70.6 ± 7.7 years with 1621 (66.6%) men and 812 (33.4%) women. ASHN involved the scalp (n = 176, 57.9%) and the face (n = 128, 42.1%). 249 patients had early stage I-II disease (39.6%) whereas 379 had late stage III-IV disease (60.4%). Most (n = 529, 45.6%) received surgery and radiotherapy (RT), 305 (26.3%) received surgery alone, 210 (18.1%) received definitive RT/chemoradiotherapy (CRT), 75 (6.5%) received surgery and CRT, and 33 (2.8%) received surgery and chemotherapy. Negative margins were achieved in 471 (55.9%) whereas 371 (44.1%) had positive margins. Mean ± SD follow-up was 41.7 ± 15.4 months. Weighted mean, 1-, 5-, and 10-year overall survival (OS) were 26.9 months, 67.3%, 30.6%, and 20.8% respectively. Mean and 5-year disease-specific survival (DSS) were 72.9 months and 50.3% respectively. Mean ± SD local recurrence rate (LRR) was 32.1 ± 11.7%. Median RT dose delivered was 60 Gy (interquartile range: 60-70). Patients who received surgery had a significantly higher mean OS (34.9 vs. 18.7 months, P = 0.04) and 5-year OS (30.1 vs. 14.2%, P = 0.01) compared with those who did not receive surgery. There was no significant difference in mean OS for receiving adjuvant chemotherapy (P = 0.99) or RT (P = 0.51). Conclusions: In the largest ASHN study to date, definitive surgical resection was associated with an improvement in OS. Multimodality treatment did not confer an OS benefit. Randomized trials are needed to establish the optimal treatment approach for ASHN.
A comparison of the burden of thyroid cancer amongst European Union 15+ countries, 1990-2017: Estimates from the Global Burden of Disease Study.
Authors: Schuster-Bruce James , Jani Chinmay , Goodall Richard , Kim Dae , Hughes William , Salciccioli Justin D , Marshall Dominic C , Shalhoub Joseph 
Published: June 2021

e18048 Background: The global incidence of thyroid cancer has been increasing rapidly and this has an attendant burden on health-systems. The Global Cancer Observatory reported an estimate of 567,233 new cases of thyroid cancer and 41,071 deaths in 2018. The objective of this study is to observe the trends in mortality, incidence and disability-adjusted life years (DALYs) from thyroid cancer between 1990-2017 in European Union (EU) 15+ nations. Methods: We extracted thyroid cancer mortality data from the Global Burden of Disease Study database based on the International Classification of Diseases versions 10 and 9. Age-standardised incidence rates (ASIR), age-standardised mortality rates (ASMR) and disability-adjusted life years (DALYs) were extracted for individual EU15+ countries per sex for each of the years 1990-2017, inclusive, and mortality-to-incidence indices (MII) were computed. Joinpoint regression analysis was used to describe trends. Results: Between 1990 and 2017, thyroid cancer ASIRs increased in all EU15+ countries for males, and in 15/19 countries for females. We identify ASIR to have plateaued in the majority of nations in the time period covered by the most recent trends. 16/19 countries observed decreasing ASMRs. Australia showed the highest increasing trends in both males (+19.2%) and females (+7.5%). The greatest decreases were seen in Belgium (-63.3%) for females and Austria for males (-34.9%). For both sexes, the MIIs decreased in all EU15+ countries. The smallest reductions were observed in the US (-22.4%) and Denmark (-22.4%) for males, and the US (-30.6%) for females. Variable directions of trends in DALYs were observed. Increasing DALYs for both genders were observed in the US and Australia. In 2017, highest ASIR was seen in Luxembourg for males (5.89/100,000) and Italy for females (8.81/100,000), highest ASMR was seen in Luxembourg for males (0.69/100,000) and females (0.53/100,000), highest MII was observed in Portugal for males (2.60/100,000) and in Finland for females (0.10/100,000) and, highest DALY was observed in Luxembourg for males (17.77/100,000) and Greece for females (16.69/100,000). Conclusions: Overall, we report EU15+ countries to be managing the burden of thyroid cancer, as evidenced by plateauing incidence rates and reductions in mortality and DALYs over the 28-year study period. However, some EU15+ countries, including the United States, demonstrate unfavorable ASMR and DALY trends. Ongoing vigilance is required to ensure changes in clinical practice and risk factor prevalence do not negatively impact on DALYs and mortality.
Characteristics of patients with lymphoma presenting initially as a neck mass referral to otolaryngology.
Authors: Lynch Andrew , Anderson Meredith , Kshirsagar Rijul , Baer David M. , Lo Joan C. , Glide Jason , Wang Kevin H. 
Published: June 2021

e18054 Background: Lymphomas that present initially as a neck mass can be challenging to diagnose as their onset is often insidious, frequently without classic symptoms, and fine-needle aspiration has limited utility for diagnosis. Understanding their clinical presentation may facilitate recognition and diagnosis, essential for timely treatment of aggressive lymphoma subtypes. Methods: Using data from a large integrated healthcare delivery system, adults aged 18-89 years without known previous cancer who were referred to Head and Neck Surgery for evaluation of a “neck mass” in 2017 were identified. Among the subset of 205 patients found to have malignancy, 76 had lymphoma (N = 69) or leukemia (N = 7) and 129 had a non-lymphoma/leukemia malignancy. The demographic characteristics of patients with and without lymphoma/leukemia were compared. Among the 69 with lymphoma, tumor histology and stage were examined. Differences between subgroups were compared using Chi-squared, Fisher’s exact, Student’s t-test, F-tests, and Tukey’s range tests for pairwise comparison. Results: Among 205 patients identified with a malignant neck mass, 76 (37%) were diagnosed with lymphoma/leukemia. Patients with lymphoma/leukemia were more likely to be female (47% vs. 27%, p = 0.003) and under age 50 years (36% vs. 13%, p = 0.001). There were no statistically significant differences in race, smoking status, or BMI between the two groups. Among the lymphoma/leukemia subset, 18 (24%) had Diffuse Large B-Cell Lymphoma (DLBCL), 13 (17%) had Follicular Lymphoma (FL), and 25 (33%) had Hodgkin’s Lymphoma (HL). The HL subset was significantly younger than both the FL and DLBCL subsets (mean age 41.6 years vs. 62.2 and 66.6, p < 0.001). A range of findings was seen when examining sex (72%, 44% and 46% male), race/ethnicity (60%, 72% and 69% non-Hispanic White), smoking status (36%, 33% and 62% current/former) and tumor stage at presentation (52%, 50% and 69% late stage (III-IV)) for HL, DLBCL and FL subtypes, respectively, but the differences were not statistically significant in these smaller subsets. Conclusions: Significant differences in baseline characteristics exist between lymphoma and non-lymphoma patients presenting with a malignant neck mass. Notably, the lymphoma subset was younger and, except for those with HL, did not demonstrate a male predominance. Within the lymphoma subset, HL patients were significantly younger than patients with other lymphoma subtypes. Further studies in a larger population identifying demographic differences by cancer subtype may inform efforts to prevent diagnostic delays in head and neck lymphoma. Characterizing the diagnostic pathway is also needed to quantify room for improvement in the treatment approach of patients with neck mass considered at higher risk for lymphoma.
Rural health cancer care: A literature review.
Authors: Swenson Wade T. , Westergard Emily , Swenson Abigail Paige 
Published: June 2021

e18500 Background: A recent review of the medical literature of rural health cancer care delivery has not been published. We conducted a preliminary review of the last twenty years of rural health cancer care delivery literature utilizing medical subject headings (MeSH) within the PubMed NCBI) database. Methods: Using PubMed MeSH Major Topic terms “rural population” and “cancer” we identified publications published from 2000 to 2020. We searched PubMed for publications that included the major topic MeSH terms “rural population” and “cancer”. We individually reviewed articles, confirmed the focus of the article, and subcategorized the articles. Results: We identified 580 publications which met the search criteria, the majority were focused on the United States (266), followed by China (56), Australia (54), and India (27). Among the publications focusing on the United States, 76 involved Appalachian States. Kentucky (18) and Georgia (10) were the states most frequently represented. Malignancies most commonly represented were: breast cancer (148), uterine/cervical (84), and colorectal cancers (68). The journals which published the most rural health cancer care delivery were The Journal of Rural Health (42), Asian Pacific Journal of Cancer Prevention (20), Cancer (14), Rural and Remote Health (13), Journal of Cancer Education (13), Australian Journal of Rural Health (12). Conclusions: The rural health cancer care literature in the last two decades focuses primarily on the United States, China, Australia, and India. Within the United States, the research focus is Appalachia. The majority of articles focus on breast cancer, uterine/cervical, and colorectal cancers. The journal which published the majority of rural health cancer care articles was the Journal of Rural Health.
Willingness to travel for CAR-T: A choice-based conjoint analysis.
Authors: Frosch Zachary AK , Namoglu Esin C. , Mitra Nandita , Landsburg Daniel Jeffrey , Nasta Sunita , Shea Judy , Bekelman Justin E. , Guerra Carmen E. , Schapira Marilyn M. 
Published: June 2021

e18503 Background: Chimeric antigen receptor T-cell therapy (CAR-T) is a novel therapy only available at specialized centers. Because patients prefer treatment close to home and provider continuity, preferences may result in unequal access. Sharing follow-up (f/u) with a local provider could increase willingness to travel, but its appeal to patients is unknown. Methods: We conducted a choice-based conjoint analysis to determine the clinical and care delivery factors that patients with diffuse-large B cell lymphoma (DLBCL) value when deciding whether to travel for CAR-T. We recruited from 13 sites within an integrated health system and asked participants to make choices between 12 pairs of treatment options that varied on 5 attributes: travel time, oncologist continuity, whether shared f/u was offered, two-year overall survival (OS), and intensive care unit (ICU) admission rate. Preferences for specific attributes were determined using a generalized estimating equation model with treatment choice as the outcome and the attributes as the variables. Each attribute’s coefficient (importance weight [IW]) represented its value to participants: higher IWs indicated greater value; negative IWs indicated undesirable attributes. Results: We invited 489 patients and 303 (62%) responded. IWs ranged from -0.56 to 1.15 (total cohort) and -2.83 to 2.50 (when modeled by race). Treatments at cancer centers ≥60 minutes away were valued less than those 30 minutes away without collaborative f/u; but were desirable if shared f/u care was offered (Table). Black respondents valued treatments ≥60 minutes away less despite shared f/u care. Participants also valued oncologist continuity (IW 1.15 [0.99, 1.32]), greater OS (IW 0.71 [0.63, 0.79] per 5 percentage point increase), and lower ICU admission rates (IW -0.21 [-0.25, -0.17] per 5 percentage point increase). Oncologist continuity was more highly valued by Black than by White respondents (IW 2.50 [1.74, 3.27] vs 1.09 [0.92, 1.25]). Conclusions: Patients with DLBCL are more likely to select CAR-T therapy at distant cancer centers if f/u care is shared locally. This could represent a strategy to expand access to CAR-T. Travel remains a barrier for Black patients despite shared f/u, suggesting the need to investigate targeted strategies that promote equitable access to CAR-T. [Table: see text]
COVID-19 communication to English- and Spanish-speaking cancer patients: A website analysis of seven healthcare systems in north Texas.
Authors: Higashi Robin T. , Sweetenham John W. , Israel Aimee D. , Tiro Jasmin A. 
Published: June 2021

e18515 Background: The COVID-19 pandemic created an urgent need for timely and accurate public health information. This is especially true for those with cancer because they face higher morbidity and mortality from COVID-19. At the same time, the disproportionate impact of the pandemic on Latinx populations underscores the need for information to reach Spanish-speakers. Given the large proportion of Spanish-speakers in the U.S., healthcare institutions have a professional and moral obligation to meet this critical need. Methods: We conducted a multi-modal, mixed method document review study to evaluate the equity of online information about COVID and cancer available to English- and Spanish-speakers from seven north Texas healthcare institutions. We sampled 50 websites (33 English, 17 Spanish) over a one-week period in May 2020. Websites included 27 healthcare institutions and 23 external organizations (e.g. CDC). Thematic content was analyzed using a coding conversion process; literacy level was measured using Readability software; accessibility was measured using the Patient Education and Materials Assessment Tool (PEMAT); and video and diversity content were defined and counted. Results: Content on Spanish websites was sub-optimal compared to English. We observed significant differences in thematic content, poor linkage to external Spanish content, and errors in translation. Whether differences were intentional was unclear. Across all sites, content specifically about COVID and cancer was more prevalent in English than Spanish (58% vs. 43%). Three institutions’ websites contained no information about COVID specifically for cancer patients, and three institutions included only a banner link to COVID updates or information from their main oncology page. Only one institution’s website included comprehensive COVID-related information specifically for cancer patients, such as postponing treatment, oral cancer treatments, and extra assurances taken for protection during in-person care; however, this website was available in English only. Spanish websites scored on average at a lower literacy level than English (11th vs. 13th grade). Using the PEMAT, healthcare institutions’ average accessibility of Spanish pages (n = 7) was slightly lower than that of English pages (n = 19) (77% vs. 81%, respectively), due mostly to discrepancies in English-only videos and visual aids; conversely, among external organizations’ websites, the average accessibility score of Spanish pages (n = 10) was higher than that of English pages (n = 13) (86% vs. 83%, respectively). Conclusions: In one region, Spanish-speakers lack equitable access to information about COVID-19 and cancer compared with English-speakers, leaving an already vulnerable patient population at greater risk for poor health outcomes. We offer recommendations for enhancing equity of access to information.