bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of primary prophylactic (PP) granulocyte-colony stimulating factor (G-CSF) use with chemotherapy dose modifications and relative dose intensity (RDI) among breast cancer patients receiving high-risk regimens for febrile neutropenia (FN).
Authors: Shaw Jaime , Schenfeld Jennifer , Balasubramanian Akhila , Jaramillo Renee , Sandschafer Darcie , Kelsh Michael Anthony , Mahtani Reshma L. 
Published: September 2021

314 Background: FN is a primary driver of chemotherapy modification and reduced RDI. Breast cancer patients often receive regimens with high risk ( > 20%) for FN. PP G-CSF use is recommended to decrease incidence of infection, as manifested by FN. Real-world evidence describing the association of G-CSF with reduced RDI in breast cancer patients is lacking. Methods: We retrospectively analyzed Flatiron Health Electronic Health Record data from 2011 to 2019 of adult female breast cancer patients initiating high-risk for FN chemotherapy regimens. PP G-CSF (pegfilgrastim, filgrastim, or biosimilars) use was assessed in the first and subsequent cycles of chemotherapy overall and by modality (on-body injector [OBI] vs. pre-filled syringe [PFS]). Standard dose was defined by NCCN guidelines. RDI was defined with respect to dose and timing of delivery: (delivered dose intensity/standard dose intensity)*100 and categorized as < 85% vs ≥85%. Characteristics were described by G-CSF use and adjusted relative risks (ARRs) were estimated for the association between G-CSF use and RDI, adjusting for age, serum hemoglobin, ECOG, HER2 status, and HR status. Results: There were 27,812 breast cancer patients included with a median age of 57 years. Most (90%) received PP-G-CSF. Four cycles of TC (docetaxel + cyclophosphamide) was the most common regimen prescribed (36%) and 82% of these patients received PP-G-CSF support in the first cycle, with OBI given more often than PFS (62% vs 38%). Second most common was dd AC-T Q1W (doxorubicin + cyclophosphamide followed by paclitaxel) and 98% of these patients received PP G-CSF (59% OBI vs 41% PFS). 80% of G-CSF users (vs 48% of those with no G-CSF) completed 4 or more cycles of chemotherapy (all regimens had ≥4 planned cycles). G-CSF users had a significant reduction in risk of RDI < 85% in Cycle 1 (ARR: 0.60; 95% confidence interval [CI]: 0.43 – 0.85) and Cycle 2 (ARR: 0.76; 95% CI: 0.59 – 0.97). At the overall chemotherapy course level, the risk of RDI < 85% was not significantly different by G-CSF use (ARR: 0.83; 95% CI: 0.63 - 1.08). There was no significant difference in risk of reduced RDI between OBI and PFS (ARR: 1.13; 95% CI: 0.94 - 1.35). Conclusions: This study revealed that 90% of breast cancer patients receiving high-risk for FN chemotherapy received PP-G-CSF support and completed more cycles than those who did not receive G-CSF. G-CSF users had lower risk of a reduced RDI in Cycles 1 and 2.
Implementation of “Epic Healthy Planet” registry for survivorship care coordination.
Authors: Kinahan Karen , Desai Bijal , Volpentesta Michele , Klein Margo , Duffy Melissa , Garcia Sofia F. , Kircher Sheetal Mehta 
Published: September 2021

337 Background: The evolving Commission on Cancer (CoC) reporting mandate and institution’s growing survivorship program led to identifying the need for systematic tracking of survivorship patients, surveillance tests, return appointments and referrals placed. Our aim was to develop an electronic medical record (EMR) integrated registry utilizing discrete data fields to assist our team in tracking key elements of high-quality survivorship care. Methods: Stakeholders from our survivorship team (APP/RN), medical oncology, psychology, research, operations and IT analytics reached consensus on essential discrete EMR fields to be included in the registry. For implementation we utilized the EPIC module, “Healthy Planet”, where patients enter the registry by initiating an “Episode of Care” at their initial survivorship visit. SmartForm fields create unique discrete patient data points identified by the stakeholders. Results: The following domains were identified as important elements of care that require tracking in a dedicated survivorship program. The registry domains populate from two sources: 1) currently existing EMR data fields, 2) domains with no currently discrete data (e.g. lymphedema, peripheral neuropathy) were captured in the developed SmartForm (see Table). From January 1, 2019 to June 1, 2021, 778 patients were entered into the registry. Since September 4, 2020, 112 patient follow-up appointment reminders were sent via EMR which has led to a noticeable increase in return appointments. SmartForm data fields are being amended as additional malignancy types are added to our survivorship program. Conclusions: The utilization of Healthy Planet is an effective and user-friendly way to track survivorship return appointments, remind providers of diagnostic tests that are due, and track referrals for CoC reporting. As the numbers of cancer survivors continues to increase, systematic population management tools are essential to ensure adherence to survivorship guideline recommendations, follow-up care and mandatory reporting.[Table: see text]
Oncologists’ perspectives on omission of sentinel lymph node biopsy in women >70 years with early-stage hormone receptor-positive breast cancer.
Authors: Minami Christina Ahn , Bryan Ava F. , Revette Anna C. , Freedman Rachel A. , King Tari A. , Mittendorf Elizabeth A. 
Published: September 2021

48 Background: Trial data show that omission of surgical axillary staging does not affect overall survival in women >70 with cT1N0 hormone receptor-positive (HR+) breast cancer, and the Society of Surgical Oncology’s Choosing Wisely recommendations advise against routine use of sentinel lymph node biopsy (SLNB) in patients with early-stage HR+ cancers. Despite this, almost 80% of women eligible for omission still undergo SLNB. We sought to explore oncologists’ perspectives of omission of SLNB in this patient population. Methods: We conducted an exploratory qualitative study using semi-structured telephone interviews with surgical, medical, and radiation breast oncologists throughout North America from 3/2020 to 1/2021. Purposive snowball sampling ensured a range of practice types. Interviews were transcribed and a team trained in qualitative analysis undertook thematic analysis guided by grounded theory to identify emergent themes. Results: Participants included sixteen surgical, six medical, and seven radiation oncologists (55% female) (Table). Overall, while oncologists in all fields expressed acceptance regarding SLNB omission in certain women >70 with cT1N0 HR+ disease, many viewed it as a complex choice based on patient comorbidities, chronologic age, patient preferences, and disease factors. Although patients’ physiologic age and life expectancy were also important decisional factors, almost all participants assessed these subjectively despite knowing that validated tools existed. Most surgeons perceived the data backing the Choosing Wisely recommendation as weak, although knowledge of specific supporting studies was low. While all participants agreed that SLNB omission does not affect survival, several radiation oncologists expressed anxiety about resultant increased regional recurrence risk. In the absence of known nodal status, medical and radiation oncologists stated they were more likely to order additional imaging, rely on OncotypeDX scores to make systemic therapy decisions, add high tangents, and be reluctant to offer partial breast irradiation. Conclusions: While surgeons are aware of the Choosing Wisely recommendation, high SLNB rates in patients eligible for omission may be driven by perceptions of the quality of the supporting data and differing ideas regarding appropriate candidacy for omission. There are downstream effects of SLNB omission on medical and radiation oncology treatment decision making and surgeons should engage in multidisciplinary discussion prior to surgery.[Table: see text]
Association between insurance plan, prior authorization, and time to receipt of oral anticancer drugs.
Authors: Lichtenstein Morgan RL , Beauchemin Melissa Parsons , Raghunathan Rohit R. , Doshi Sahil D , Law Cynthia , Accordino Melissa Kate , Elkin Elena B. , Wright Jason Dennis , Hershman Dawn L. 
Published: September 2021

6 Background: The past decade has seen a dramatic increase in the number of Food and Drug Administration approvals of oral anti-cancer drugs (OACDs). Most OACD prescriptions require coordination between payers and providers, which can delay drug receipt. In May 2021, two bills were introduced in the US House of Representatives (HR 3173 and HR 3258) to streamline the prior authorization (PA) process. In this study, we examined clinical and process-related factors associated with PA and time to drug receipt (TTR) for patients who received a new OACD prescription. Methods: We prospectively collected data on all new OACD prescriptions for adult oncology patients from 1/1/2018 to 12/31/2019. We collected patient demographic, medical, and insurance data, drug type (hormonal, chemotherapy, targeted), and specialty pharmacy interactions with payers and financial assistance groups, including PA information. TTR was defined as the number of days from OACD prescription to patient receipt of the drug. We used multivariable logistic regression to separately assess factors associated with TTR and factors associated with PA for patients who received a new OACD prescription. Results: The cohort for both models included 883 patients who were prescribed 1014 new OACDs. Of these prescriptions, 72.3% (N=733) required PA. The median age was 66 and 44% identified as White. The median TTR was 7 days (IQR 0 – 142; 25% ≥ 14 days; and 5% ≥ 30 days). In unadjusted analyses, PA was associated with insurance and drug type and delayed TTR was associated with PA and insurance type. In a multivariable analysis, patients with Medicaid insurance were more likely to require PA compared to patients with Medicare (OR 1.93 (1.14 – 3.32), p=0.03). In addition, patients prescribed targeted and hormone therapies were more likely to require PA than those prescribed oral chemotherapy (targeted: OR 3.33 [2.38 – 4.68], p<0.001; hormone: OR 4.26 [2.45 – 7.65], p<0.001). A separate multivariable analysis showed that PA is associated with delayed TTR (OR 1.62 [1.18 – 2.24], p=0.003) and that Medicaid is associated with a shorter TTR (OR 0.59 [0.37 – 0.94], p=0.03). Conclusions: The current process for obtaining OACDs is complex and multifaceted. Seventy two percent of delivered OACDs require PA, which is associated with delayed TTR. Earlier intervention and new health policies are needed to reduce time to OACD receipt. [Table: see text]
Breast cancer patients therapeutic adherence during the COVID-19 pandemic in Indonesia: Knowledge level analytical study.
Authors: Soewoto Widyanti 
Published: September 2021

89 Background: Corona virus diseases 2019 (COVID-19) pandemic is a new challenge for Indonesia's cancer patient’s treatment. Patients face problems in undergoing therapy during the pandemic due to government lockdown regulations. Cancer patients, especially breast cancer, still do not understand how to deal with this problem. This study aims to determine COVID-19 knowledge’s effect on therapeutic adherence in breast cancer patients in Indonesia. Methods: This study was a cross-sectional study conducted from February to April 2021. This study involved breast cancer patients from various regions in Indonesia. The research instrument employed the UNS-CASKQ14 questionnaire (Universitas Sebelas Maret-Cancer Altitude Satisfaction Knowledge Questionnaire) to determine COVID-19 knowledge and therapeutic adherence levels in breast cancer patients. The data were then tested the Spearman Rho correlation utilizing SPSS 25. Results: There were 812 respondents in this study, with the most respondents in the age range of 50-59 years (31.8%). As many as 222 (27.3%) respondents had a low knowledge level about COVID-19, 511 (62.9%) respondents had a sufficient knowledge level, and 79 (9.8%) respondents had a good knowledge level. As many as 369 (45.4%) respondents had a low therapeutic adherence level, and 443 (54.6%) respondents had a good adherence level during the COVID-19 pandemic. Based on the Spearman Rho correlation test between COVID-19 knowledge and therapeutic adherence levels, the results obtained were p = 0.51 (p > 0.05), with the Spearman Rho coefficient value = 0.026. Conclusions: There was no significant effect between COVID-19 knowledge and therapeutic adherence levels in breast cancer patients during the COVID-19 pandemic in Indonesia.
Resolving transportation disparity in cancer care.
Authors: Marquez Rachel , Manning Matthew A. , Mohamed Mohamed K. 
Published: September 2021

96 Background: Improving healthcare value requires new models of care including higher utilization of outpatient services. A significant social determinant of health in this mode of care is transportation, and the most vulnerable segments of society are disproportionately affected. Transportation disparity is especially troubling in radiation oncology, due to the protracted daily treatment schedule. Disruptions in treatment adversely impact clinical outcomes and survivals. This study is a pilot trial of a novel virtual logistics hub, capable of managing rideshare, taxis, wheelchair accessible vehicles, vehicles with car seats for children and stretcher vehicles in radiation oncology to measure utilization, patient satisfaction and financial impact. Methods: Over 4 months, using predictive analytics, patients with transportation barriers in a community cancer center were enrolled in a rideshare program. Those who received rides for radiation treatment were included in this study. Each patient's personal historic no-show rate in the health system was recorded. The estimated cost per no-show for a radiation treatment was set at $250. The opportunity cost was calculated as the product of the no-show rate, the no-show cost per treatment and the number of treatments. In addition, the cost of the transportation was recorded and subtracted from the opportunity cost to calculate the return on investment ROI. Qualitative data were also collected through patient surveys after each ride. Results: 29 subjects were included in this IRB-approved pilot study for a total of 419 rides. The most common diagnoses were Breast (27.6%), Lung (17.2%) and Prostate (17.2%). Most patients were racial minorities (70.0%) and had non-metastatic disease (75.9%). The median number of radiation treatments was 10 (3-40). The historic average no-show rate was 7% (0%-36%). The average expected no show cost per patient was $219.14 ($0.00-$1,837.50). The opportunity cost representing the benefit to the health system was $6,355.00. Per patient, the average transportation cost was $325.81 ($13.26-$1,034.39). The total cost of rides was $11,864.77. The ROI was -$5,509.77. When asked 'How would you rate your transportation experience today?' 82% responded Above Average. To the question 'Would you have been able to attend your appointment today if this program did not exist?' 92% answered No. Conclusions: This study shows that the cost of rideshare transportation can partially offset the cost of no-shows. This suggests that a proactive virtual transportation hub can help address transportation barriers, drive patient satisfaction and reduce the waste of no-shows. Radiation therapy represents an ambulatory medicine crucible for patients with limited transportation and social support. Scaling up rideshare innovations from radiation oncology has the potential to drive broader ambulatory strategy.
Novel zebrafish polycystic kidney disease models reveal functions of the Hippo pathway in renal cystogenesis
Authors: Ren Zhiqin , Zhang Zhiwei , Liu Tzu-Ming , Ge Wei 
Published: September 2021

ABSTRACT
The Hippo signaling pathway is a kinase cascade that plays an important role in organ size control. As the main effectors of the Hippo pathway, transcription coactivators Yap1/Wwtr1 are regulated by the upstream kinase Stk3. Recent studies in mammals have implicated the Hippo pathway in kidney development and kidney diseases. To further illustrate its roles in vertebrate kidney, we generated a series of zebrafish mutants targeting stk3, yap1 and wwtr1 genes. The stk3−/− mutant exhibited edema, formation of glomerular cysts and pronephric tubule dilation during the larval stage. Interestingly, disruption of wwtr1, but not yap1, significantly alleviated the renal phenotypes of the stk3−/− mutant, and overexpression of Wwtr1 with the CMV promoter also induced pronephric phenotypes, similar to those of the stk3−/− mutant, during larval stage. Notably, adult fish with Wwtr1 overexpression developed phenotypes similar to those of human polycystic kidney disease (PKD). Overall, our analyses revealed roles of Stk3 and Wwtr1 in renal cyst formation. Using a pharmacological approach, we further demonstrated that Stk3-deficient zebrafish could serve as a PKD model for drug development.
Tumor size-based validation of contrast-enhanced ultrasound liver imaging reporting and data system (CEUS LI-RADS) 2017 for hepatocellular carcinoma characterizing
Authors: Pan Jia-Min , Chen Wei , Zheng Yan-Ling , Cheng Mei-Qing , Zeng Dan , Huang Hui , Huang Yang , Xie Xiao-Yan , Lu Ming-De , Kuang Ming , Hu Hang-Tong , Chen Li-Da , Wang Wei 
Published: September 2021

Objectives:
To validate the efficacy of contrast-enhanced ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) and its major features in diagnosing hepatocellular carcinoma (HCC) of different sizes in high-risk patients.

Methods:
Between January 2014 and December 2015, a total of 545 untreated liver nodules were included. These liver nodules were divided into two groups (&lt;20 mm and ≥20 mm). Each nodule was classified based on CEUS LI-RADS. The diagnostic performance comparison was assessed by the chi-square test, with pathology results as the golden criterion.

Results:
The accuracy, sensitivity, specificity, and positive predictive value (PPV) of CEUS LR-5 criteria in &lt;20 mm group vs ≥20 mm group in diagnosing HCC were 60.5% vs 59.8%, 55.6% vs 57.6%, 85.7% vs 88.6 and 95.2% vs 98.5%, respectively, without significant difference (all p &gt; 0.05). The accuracy, sensitivity and PPV of LR5/M for malignancy in &lt;20 mm group were lower than in ≥20 mm group, with values of 79.1% vs 95.0%, 84.2% vs 95.7 and 91.4% vs 99.2%, respectively (p &lt; 0.05).

Conclusions:
The CEUS LI-RADS has a comparable performance for diagnosing HCC between lesions ≥ 20 mm and &lt;20 mm. For diagnosing malignancy including HCC, it has a higher efficacy for lesions ≥ 20 mm than &lt;20 mm.

Advances in knowledge:
1.For diagnosing HCC, CEUS LI-RADS has comparable performances between lesions ≥ 20 mm and &lt;20 mm.
2. For diagnosing malignancy including HCC, CEUS LI-RADS has a higher efficacy for lesions ≥ 20 mm than &lt;20 mm.
Low-dose radiation therapy for COVID-19 pneumonia: a pilot study
Authors: Sharma Daya Nand , Guleria Randeep , Wig Naveet , Mohan Anant , Rath Goura , Subramani Vellaiyan , Bhatnagar Sushma , Mallick Supriya , Sharma Aman , Patil Pritee , Madan Karan , Soneja Manish , Thulkar Sanjay , Singh Angel , Singh Sheetal 
Published: September 2021

Objectives:
The World Health Organization (WHO) has declared coronavirus disease 2019 (COVID-19) as pandemic in March 2020. Currently there is no specific effective treatment for COVID-19. The major cause of death in COVID-19 is severe pneumonia leading to respiratory failure. Radiation in low doses (&lt;100 cGy) has been known for its anti-inflammatory effect and therefore, low dose radiation therapy (LDRT) to lungs can potentially mitigate the severity of pneumonia and reduce mortality. We conducted a pilot trial to study the feasibility and clinical efficacy of LDRT to lungs in the management of patients with COVID-19.

Methods:
From June to Aug 2020, we enrolled 10 patients with COVID-19 having moderate to severe risk disease [National Early Warning Score (NEWS) of ≥5]. Patients were treated as per the standard COVID-19 management guidelines along with LDRT to both lungs with a dose of 70cGy in single fraction. Response assessment was done based on the clinical parameters using the NEWS.

Results:
All patients completed the prescribed treatment. Nine patients had complete clinical recovery mostly within a period ranging from 3 to 7 days. One patient, who was a known hypertensive, showed clinical deterioration and died 24 days after LDRT. No patients showed the signs of acute radiation toxicity.

Conclusion:
The results of our pilot study suggest that LDRT is feasible in COVID-19 patients having moderate to severe disease. Its clinical efficacy may be tested by conducting randomized controlled trials.

Advances in knowledge:
LDRT has shown promising results in COVID-19 pneumonia and should be researched further through randomized controlled trials.
General public awareness, knowledge and attitude toward COVID-19 infection and prevention: a cross-sectional study from Pakistan
Authors: Alam Beenish Fatima , Almojaibel Abdullah A. , Aziz Ansari Khalid , Haroon Mohammad , Noreen Sara , Tauqir Saman , Almas Khalid , Farooqi Faraz A. , Ali Saqib 
Published: September 2021

Background: The aim of this study is to evaluate the knowledge, perceptions, and attitude of the public in Pakistan (using social media) towards COVID-19. Methods: A cross-sectional study was conducted amongst 1120 individuals nationwide. A self-developed, pre-tested questionnaire was used that comprised of sections covering demographic characteristics, medical history, hygiene awareness, COVID-19-related knowledge, and learning attitude. Descriptive statistics were used for frequencies, percentages, averages and standard deviations. Inferential statistics were done using the Student’s t-test and ANOVA. Results: The average age of participants was 31 years (range 18-60 years). In total 56 individuals (5%) had completed primary or secondary school education; 448 (40%) were employed (working from home) and 60% were jobless due to the COVID-19 crisis. Almost all the study subjects (1030 (92%)) were washing their hands multiple times a day. A total of 83% had awareness regarding quarantine time, 82% used face masks whenever they left their homes, 98% were aware of the origin of the disease, and 70% had knowledge regarding the most common symptoms of COVID-19. Conclusion: It can be concluded from the current study that female participants had higher level of education, and more awareness regarding the coronavirus. The majority of the participants followed proper hand washing regimes and washed their faces. Further knowledge and awareness should be promoted.