bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mobile low-dose computerized tomography (LDCT): Three-year follow up of solution for early diagnosis of lung cancer in under-served populations.
Authors: Raghavan Derek , Doege Darcy L. , Wheeler Mellisa S , Dungan Kia , Davis Lauren , Doty John , Hickman Glenn , Weatherford Brooke , White Stephanie , Mileham Kathryn Finch , Carrizosa Daniel R. 
Published: June 2021

6507 Background: Randomized trials have proven that screening high-risk patients with LDCT of chest reduces lung cancer mortality compared to screening with chest x-ray. Under-served patients lack access to this test due to geographic and socio-economic factors. We hypothesized that a mobile screening unit would improve access and increase survival in this group, which is most at risk of lung cancer deaths. Methods: We installed a BodyTom portable 32 slice low-dose CT scanner (Samsung Inc) into a 35 foot coach (Frazier Inc), reinforced to avoid equipment damage during road travel. It includes waiting area, high speed wireless internet connection for rapid image transfer, and electronic tablets to deliver smoking cessation and health education programs and shared decision-making video aids. We used LUNG RADS approach to lesion classification, yielding high sensitivity and specificity in assessment. All films were reviewed by a central panel. This is certified as a lung cancer screening Center of Excellence by the Lung Cancer Alliance. Protocol was approved by Advarra IRB. Medicare pts excluded as insurance covered them for LDCT, although this reduced potential number of cases diagnosed as this is highest risk population. Results: We screened 1200 uninsured or under-insured subjects, mean age 61 years (range 55-64), with average pack year history of 47.8 (30-150); 61% male; 18% Black, 3% Hispanic/Latino; 78% rural. We found 97 pts with LUNG RADS 4 lesions, 30 lung cancers (2.5%), including 15 at stage I-II treated with curative intent; 5 incidental non-lung cancers (renal CA 2, head & neck CA 1, pancreas CA 2); more than 50% with cardiovascular disease or COPD seen on LDCT. Of eligible first-screen subjects (J. Clin. Oncol., 2019, 37, 383S), 440 attended Year 1 repeat LDCT and 161 attended Year 2 LDCT. Only one pt with surgically resected CA lung has relapsed to date. Conclusions: Mobile LDCT yields higher screening rate for under-served pts than prior international studies, with strong protocol adherence and paucity of early cancer deaths in high-risk population with traditionally poor compliance.
Measuring disparities in quality of oncology care across oncology practices.
Authors: Keating Nancy Lynn , Landrum Mary Beth , Zaslavsky Alan , Samuel Cleo A. , Sinaiko Anna , Brooks Gabriel A. , Wright Alexi A. , Bai Barbara 
Published: June 2021

6533 Background: Equity is now recognized as an essential aspect of health care quality. Racial inequities in clinical performance diminish overall system performance. We assessed the feasibility and reliability of practice-level measures of racial disparities in chemotherapy-associated emergency department (ED) visits and hospitalizations. Methods: Using fee-for-service Medicare data, we identified 1,196,970 Black or White fee-for-service Medicare beneficiaries with cancer receiving chemotherapy in 2016-2019, who were attributed to 5511 oncology practices that treated at least 1 Black and 1 White beneficiary (96.4% of all beneficiaries). We studied two CMS quality measures: chemotherapy associated ED visits and chemotherapy associated hospitalizations. For each outcome, we estimated multi-level models with separate practice-level random intercepts for Black and White patients to quantify practice-level Black-White disparities in adjusted rates of these measures and assess the associations of these rates with the proportion of Black patients in the practice. Results: Overall, 108,177 Black and 966,381 White beneficiaries with cancer were treated at 1321 practices with reliable estimates (reliability ≥70%) of Black-White differences in rates of chemotherapy-associated ED visits; 101,411 Black and 915,895 White beneficiaries were treated at 1,012 practices with reliable estimates of chemotherapy-associated hospitalizations. These practices treated 80% or more of all Black and White beneficiaries; 10% of these practices treated 75% of Black beneficiaries. The median adjusted Black-White rate difference across practices was +8.9% [interquartile interval (IQI) +5.0%, +12.8%; 5th, 95th percentile -1.8 to +19.2%] for chemotherapy associated ED visits and +4.4% [IQI +1.3%, +7.7%; 5th, 95th percentile -3.5% to +13.5%] for chemotherapy associated hospitalizations. Chemotherapy-associated ED visit rates were 3.2 percentage points higher for Black vs White patients (P <.001) at the practice with the mean % of Black patients, but the difference was smaller in practices with more Black patients (0.4 percentage points less for each 10% increase in Black share, P <.001). Chemotherapy-associated hospitalization rates were 0.6 percentage points lower for Black vs White patients (P =.01) but did not vary by practice racial composition. Conclusions: Using data from more than 1000 practices over 4 years, we calculated reliable estimates of practice-level racial disparities in chemotherapy-associated ED visits and hospitalizations. Practice-level performance for these quality measures was generally lower for Black versus White beneficiaries. Measuring and providing feedback on practice-level Black-White disparities in oncology performance measures may be one effective tool for advancing racial equity in care quality for cancer patients receiving chemotherapy.
What accounts for the racial disparity in survival from estrogen receptor-positive, axillary node-negative breast cancer in the United States? An analysis of the SEER-Oncotype database.
Authors: Hoskins Kent , Calip Gregory Sampang , Danciu Oana Cristina , Rauscher Garth H 
Published: June 2021

6534 Background: In a previous analysis of the SEER-Oncotype database (Hoskins, et al. JAMA Oncol, 2021), we reported that among women with estrogen receptor (ER)-positive, axillary node-negative breast cancer (BC), Black women were more likely than non-Hispanic White (White) women to have a high risk Oncotype Recurrence Score (RS), and the adjusted hazard for BC-specific death was 1.5-2.5 times higher for Black than for White women within each RS risk category. In this study we examined the role of health insurance, census tract socioeconomic status and tumor biology in the racial disparity in ER-positive BC mortality among US women. Methods: We obtained BC-specific survival data from the SEER-Oncotype database for women diagnosed with first primary, stages I-II, ER-positive, node-negative BC between 1/1/2004 -12/31/2015 who had an Oncotype Recurrence Score (RS) through Genomic Health Laboratory. The racial (Black:White) BC mortality disparity was estimated as a disparity hazard ratio (HR) from a series of Cox proportional hazards models of time to BC death. The baseline model adjusted for SEER registry and age at diagnosis (included in all models). We estimated the disparity HR after controlling for variable domains one at a time, as well as cumulatively in this order: neighborhood SES index (a composite measure including census tract education, income and poverty) and insurance (none, public, private); tumor biology (RS, PR status, tumor grade); tumor size; and treatment (surgery type, initiation of radiation and chemotherapy). Results: The analysis included 57,428 White and 6,003 Black women with node-negative, ER-positive BC (median follow-up = 54 months). The total disparity HR for BC death was 1.67 (95% CI: 1.37, 2.02). Tract SES and insurance together accounted for 21% of the disparity HR (adjusted HR 1.52, 95% CI: 1.22, 1.88); most of this was due to differences in insurance status, with tract SES accounting for 7% of the disparity when considered in isolation. Tumor biology (RS, PR status and grade) accounted for 30% of the disparity (adjusted HR = 1.41, 95% CI:1.14, 1.75); together, the domains of social determinants and tumor biology accounted for 50% of the disparity HR (adjusted HR = 1.30, 95% CI: 1.04, 1.62). Tumor size and treatment initiation each explained roughly 10% of the disparity HR when considered in isolation but did not account for any of the disparity once other factors were accounted for. Results obtained from additional methods for mediation analyses, including a method of rescaled coefficients and structural equation modeling (SEM) applied to discrete-time survival analysis will also be presented. Conclusions: In this study of node-negative, ER-positive BC, much of the BC survival disparity among US women could be explained by racial differences in measured tumor biology and social determinants of health.
One size does not fit all: Evaluating disparities in lung cancer screening eligibility amongst Hispanic/LatinX and African Americans.
Authors: Olazagasti Coral , Ehrlich Matthew , Kohn Nina , Seetharamu Nagashree 
Published: June 2021

6538 Background: Lung cancer (LC) is the leading cause of cancer death among Hispanic men. African Americans (AA) have the highest LC mortality rate in the United States (US). We sought to identify the tendencies for screening eligibility amongst Hispanic/LatinX (H/L) and AA prior to their LC diagnosis according to the National Comprehensive Cancer Network (NCCN) and The United States Preventive Service Task Force (USPSTF) guidelines. Methods: We conducted an observational study in patients diagnosed with LC from 2016 to 2019. Current and former smokers were included in the analysis. Charts were reviewed for demographics, smoking history, family history, personal history of other malignancy, and prior exposures to assess screening their eligibility prior to LC. The chi-square test was used to examine the association between race and ethnicity with each screening criteria. Results: A total of 530 subjects were reviewed, of which 428 were included in the analysis. One hundred and fifty three and 245 subjects were ineligible for NCCN and USPSTF screening criteria prior to their LC diagnosis. Twenty-eight of the subjects failing to meet NCCN criteria identified as AA and 12 as H/L. Forty and 20 of the USPSTF ineligible subjects identified as AA and H/L. There was a significant association between ethnicity and individual screening eligibility, where 52% of H/L met NCCN eligibility compared to 20% of H/L who met USPSTF eligibility (p = 0.0010). There was a significant association between ethnicity and USPSTF criteria (p = 0.0166), as 80% of H/L subjects were screening ineligible under USPSTF criteria compared to 56% of non-Hispanic or other [Table]. Conclusions: In our study, H/L had significant lower tendencies of meeting the USPSTF LC screening eligibility criteria than non-H/L or other. Notably, there was a profound association between ethnicity and eligibility of screening criteria, where a proportionally higher number of H/L who were ineligible under USPSTF criteria met NCCN criteria. These findings suggest that leniency in the screening criteria can possibly lead to earlier detection of lung cancer in high-risk individuals. Our study is in line with developing data that minority individuals at high-risk for lung cancer can be missed, mainly if current USPSTF criteria was to be applied. Recently, USPSTF has modify their criteria which may benefit more of these individuals. To improve rates of screening and overall mortality of minorities, organizations should continue to re-evaluate and liberalize their screening guidelines.[Table: see text]
Barriers to web-based symptom management systems (web-SyMS).
Authors: Hassett Michael J. , Tramontano Angela , Cronin Christine , Osarogiagbon Raymond U. , Wong Sandra L. , Bian Jessica J , Hazard Hannah W. , Dizon Don S. , Schrag Deborah ,   SIMPRO Investigators
Published: June 2021

6545 Background: Web-SyMS can reduce the burdens of cancer and its treatment. While patients frequently express willingness to use these systems, only a subset actively engages with them. Some patients may lack the tools and confidence needed to benefit from web-SyMS. We sought to characterize these barriers among community-based cancer patients receiving care across six diverse healthcare systems. Methods: We surveyed patients receiving chemotherapy at three healthcare systems (Baptist, TN; Maine Medical, ME; Dana-Farber, MA) and patients recovering from cancer-directed surgery at three healthcare systems (West Virginia University, WV; Dartmouth-Hitchcock, NH; Lifespan, RI). Surveys were conducted as part of a pre-implementation analysis of eSyM – an EHR-embedded web-SyMS that collects, tracks, and manages patient reported outcomes during cancer therapy. Results: Among 563 respondents, access to tech devices (i.e., tablet, computer, or smartphone) was high: 78% reported access to ≥2 devices and only 5% reported access to no devices. However, confidence using tech devices to accomplish online tasks varied: 45% very confident, 38% somewhat confident, 11% little-no confidence. Compared to medical oncology patients, surgery patients were more likely to report being very confident (57% vs. 31%). There were significant differences based on patients’ self-reported tech confidence (Chi-square P<.05 for all values in the table). Conclusions: Low self-reported tech confidence may identify patients who are at high risk for experiencing the burdens of cancer but may be less likely to benefit from web-SyMS. Addressing this barrier is critical to improving outcomes and addressing disparities. Clinical trial information: NCT03850912. [Table: see text]
Impact of cancer on the risk of unplanned 30-day readmissions.
Authors: Qian Alexander , Qiao Edmund , Nalawade Vinit , Kotha Nikhil V. , Voora Rohith S. , Murphy James Don 
Published: June 2021

6581 Background: Hospital readmission are associated with unfavorable patient outcomes and increased costs to the healthcare system. Devising interventions to reduce risks of readmission requires understanding patients at highest risk. Cancer patients represent a unique population with distinct risk factors. The purpose of this study was to define the impact of a cancer diagnosis on the risks of unplanned 30-day readmissions. Methods: We identified non-procedural hospital admissions between January through November 2017 from the National Readmission Database (NRD). We included patients with and without a cancer diagnosis who were admitted for non-procedural causes. We evaluated the impact of cancer on the risk of 30-day unplanned readmissions using multivariable mixed-effects logistic regression models. Results: Out of 18,996,625 weighted admissions, 1,685,099 (8.9%) had record of a cancer diagnosis. A cancer diagnosis was associated with an increased risk of readmission compared to non-cancer patients (23.5% vs. 13.6%, p < 0.001). However, among readmissions, cancer patients were less likely to have a preventable readmission (6.5% vs. 12.1%, p < 0.001). When considering the 10 most common causes of initial hospitalization, cancer was associated with an increased risk of readmission for each of these 10 causes (OR range 1.1-2.7, all p < 0.05) compared to non-cancer patients admitted for the same causes. Compared to patients aged 45-64, a younger age was associated with increased risk for cancer patients (OR 1.29, 95%CI [1.24-1.34]) but decreased risk for non-cancer patients (OR 0.65, 95%CI [0.64-0.66]). Among cancer patients, cancer site was the most robust individual predictor for readmission with liver (OR 1.47, 95%CI [1.39-1.55]), pancreas (OR 1.36, 95%CI [1.29-1.44]), and non-Hodgkin’s lymphoma (OR 1.35, 95%CI [1.29-1.42]) having the highest risk compared to the reference group of prostate cancer patients. Conclusions: Cancer patients have a higher risk of 30-day readmission, with increased risks among younger cancer patients, and with individual risks varying by cancer type. Future risk stratification approaches should consider cancer patients as an independent group with unique risks of readmission.
Molecular annotation of extramedullary acute myeloid leukemia to identify prevalence of targetable mutations.
Authors: Ball Somedeb , Knepper Todd C , Deutsch Yehuda Ethan , Bhagat Chirag K , Watts Justin M. , Bradley Terrence J , Samra Wassim , Chan Onyee , Hussaini Mohammad Omar , Sweet Kendra L , Talati Chetasi , Padron Eric , Komrokji Rami S. , Lancet Jeffrey E. , Sallman David Andrew 
Published: June 2021

7024 Background: Extramedullary (EM) involvement, including myeloid sarcoma (MS) and leukemia cutis (LC), is uncommon in patients with acute myeloid leukemia (AML). Mutational landscape of EM-AML is not well characterized, including concordance of sequencing data from EM vs. non-EM site (blood or bone marrow) and the potential for personalized targeted therapy in this patient cohort. Methods: In a multicenter retrospective study, clinical and genomic data were collected on EM-AML patients treated at Moffitt Cancer Center, Memorial Healthcare System, and University of Miami, as well as sequenced cases at a central laboratory. Next generation sequencing (NGS) data come from panels that interrogated 24- 406 genes, with 15 genes covered by all panels, including notably, IDH1, IDH2, KIT, KRAS, NPM1, NRAS, and TP53. Survival estimates using Kaplan-Meier statistics and multivariate analysis with Cox-regression were performed in SPSS (v.26). Results: Our study included 58 patients with EM-AML. Median age at diagnosis was 62 years; 55% of patients were males. In our cohort, 34 (59%) patients had MS, and 19 (33%) had LC. EM-AML was noted during relapse in 60% of evaluable patients (n=45), and 31% had isolated EM disease. Patients with LC had a significantly worse median overall survival (OS) than those with MS (5.7 months vs. 21.9 months, p= 0.008); Pattern of EM involvement (MS vs. LC) remained an independent prognostic factor for OS (p= 0.04) in a multivariate analysis including disease setting (new diagnosis vs. relapse) and ELN risk category. Results of NGS performed during EM presentation were available in 48 patients, 19 of which had NGS data from EM site. Most commonly mutated genes were NRAS on EM site NGS (37%) and NPM1 on non-EM site NGS (28%). Based on EM NGS, 52% patients had a targetable genomic alteration, with 37% mutations in IDH, 21% NPM1, 5% FLT3, and 11% MLL-PTD. Five (two with concurrent M+EM disease) out of nine evaluable patients had significant discordance in targetable mutations between EM and non-EM NGS at EM-AML. Three of four patients who received treatment with IDH1/2 inhibitors based on EM NGS achieved complete response. Conclusions: EM-AML has a distinct molecular architecture with an inferior OS in LC vs. MS patients. We conclude that EM site NGS is critical in patients with EM-AML, as 52% have potentially targetable mutations and could benefit from specific targeted therapies.[Table: see text]
Early results of phase 1 study of JSP191, an anti-CD117 monoclonal antibody, with non-myeloablative conditioning in older adults with MRD-positive MDS/AML undergoing allogeneic hematopoietic cell transplantation.
Authors: Muffly Lori S. , Chin Michelle , Kwon Hye-Sook , Lieber Cara , Smith Steven , Sikorski Robert , Shizuru Judith , Pang Wendy , Artz Andrew S. 
Published: June 2021

7035 Background: Myeloablative allogeneic hematopoietic cell transplantation (AHCT) is potentially curative for myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML), but toxicities of conditioning limit its use in older or frail patients. Non-myeloablative (NMA) conditioning achieves better tolerability, at the expense of higher rates of relapse. We have developed a first-in-class monoclonal antibody (mAb), JSP191, which inhibits stem cell factor binding to CD117 (c-Kit), thereby depleting normal and MDS/AML disease-initiating hematopoietic stem cells (HSC). In pre-clinical models, anti-CD117 mAbs potently synergize with low dose total body radiation (TBI) to deplete HSC and facilitate donor cell engraftment. We reasoned that adding JSP191 to a standard NMA conditioning of 2 Gy TBI and fludarabine (Flu) would be safe and result in depletion of measurable residual disease (MRD) in older adults with high-risk MDS/AML entering AHCT. Methods: We report on the first 6 enrolled subjects in our Phase 1 trial (NCT#04429191) of JSP191/TBI/Flu as AHCT conditioning in MDS/AML patients, ≥ 60 years, with MRD detected by cytogenetics (cyto), difference from normal flow cytometry (flow), and/or next-generation sequencing (NGS). Primary endpoints are safety and tolerability of JSP191/TBI/Flu and JSP191 pharmacokinetics. Secondary endpoints include engraftment, donor chimerism, MRD clearance, GVHD, NRM, EFS, and OS at 1 year. JSP191 at 0.6 mg/kg was administered intravenously; serum concentration of JSP191 was used to confirm timing to begin Flu at 30 mg/m2/day x 3 days [Transplant Day (TD)-4, -3, -2] and TBI 2 Gy on TD0. Peripheral blood grafts from HLA-matched related or unrelated donors were administered on TD0 (10-13 days after JSP191). GVHD prophylaxis was tacrolimus, sirolimus, and mycophenolate mofetil. Results: All subjects are still on trial, and there have been no infusion toxicities and no JSP191-related serious adverse events. All subjects engrafted with neutrophil recovery TD+19 to TD+26, and showed ≥94% donor myeloid chimerism in the blood at TD+28. All 3 evaluable subjects with TD+90 follow up showed complete donor (≥95%) total and myeloid chimerism and MRD elimination (Table). Conclusions: These early results are the first to demonstrate that JSP191/TBI/Flu is safe, well-tolerated, and capable of clearing MDS/AML MRD in older adults undergoing NMA AHCT. Clinical trial information: NCT04429191. [Table: see text]