bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utilization and outcome of systemic chemotherapy for high-risk early-stage cervical cancer.
Authors: Takekuma Munetaka , Matsuzaki Shinya , Matsuo Koji 
Published: June 2021

e17521 Background: To examine trends and outcomes of systemic chemotherapy for high-risk early-stage cervical cancer. Methods: This retrospective observational study queried the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program from 2000-2016. Surgically-treated women with stage T1-2 cervical cancer who had high-risk factors (lymph node metastasis and/or parametrial invasion) and received adjuvant therapy were examined. Propensity score inverse probability of treatment weighting was used to assess the survival estimates for chemotherapy use versus external beam with chemotherapy (CCRT). Results: Among 2, 462 women with high-risk factor, 185 (7.5%) received systemic chemotherapy. Utilization of chemotherapy has significantly increased over time in multivariable analysis (adjusted-odds ratio per 1-year increment, 1.06, 95% confidence interval [CI] 1.02-1.09). In weighted models, adjuvant chemotherapy and CCRT had comparable survival among women aged < 40 (hazard ratio [HR] for all-cause mortality 0.73, 95%CI 0.41-1.33), adenocarcinoma or adenosquamous histologies (HR 0.90, 95%CI 0.62-1.32), and high-risk group based on nodal metastasis alone (HR 1.17, 95%CI 0.84-1.62). In contrast, chemotherapy was associated with increased all-cause mortality compared to CCRT among women aged ≥40 (HR 1.57, 95%CI 1.19-2.06), squamous histology (HR 1.63, 95%CI 1.19-2.22), and high-risk group per parametrial invasion alone (HR 1.87, 95%CI 1.09-3.20) or parametrial invasion with nodal metastasis (HR 1.64, 95%CI 1.06-2.52). Conclusions: Utilization of systemic chemotherapy for high-risk early-stage cervical cancer is increasing in the United States. Survival effects of adjuvant chemotherapy varied per patient and tumor factors, and this indication may be limited to those who are < 40 years with non-squamous histology and absence of parametrial invasion.
IL-17A and CCL2 in blood serum and circulating neutrophils in patients with ovarian tumors.
Authors: Gening Snezhanna , Abakumova Tatyana , Gening Tatyana 
Published: June 2021

e17536 Background: During the ovarian carcinogenesis, circulating neutrophils (Nph) phenotype switches to the pro-tumor, with an increase in the Nph C-C motif ligand 2 (CCL2) expression. Proinflammatory interleukin-17A (IL-17A) is able to induce the CCL2 expression in Nph. The study aimed to evaluate the IL-17A and CCL2 levels in serum and circulating Nph in patients with ovarian tumors. Methods: The study included 97 ovarian cancer (OC) patients, 30 patients with benign ovarian tumors (BT) and the control (n=22). The levels of IL-17A (LLC "Cytokine", Russia) and CCL2 (Vector-Best-Volga, Russia) in serum and Nph lysate were assessed by ELISA. The systemic inflammation was assessed by neutrophil to lymphocyte ratio (NLR). Informed voluntary consent was obtained from all women. Statistical processing was performed using one-way ANOVA, Spearman correlations (Statistica 13.0 (TIBCO, USA)). Results: We found an increase in NLR in BT (4.3 ± 1.0) compared with the control (2.2 ± 0.1) (p = 0.020), a decrease in stage I-II OC (2.4 ± 0.2) compared with BT (p = 0.053), and an increase in stage III (4.5 ± 0.9) and IV (4.6 ± 0.5) compared with stage I-II OC (p = 0.054 and p = 0.046, respectively). The cytokines levels are presented in Table. The serum level of IL-17A in BT was higher than in the control (p = 0.010). In stage I-II OC, the serum IL-17A level was decreased in comparison with the BT (p = 0.004). In stage IV OC, the serum IL-17A was higher than in stage I-II (p = 0.015) and the control (p = 0.017). The level of IL-17A in Nph in BT did not differ from the control. In all stages of the OC, the IL-17A Nph level was lower than in the control (p1, 2, 3 = 0.0001). In stage IV OC, the expression of IL-17A in Nph was lower compared with stage III (p = 0.031). The serum and Nph levels of IL-17A were correlated only in stage I-II OC (r = 0.679, p = 0.011). The CCL2 serum levels in BT (p = 0.0002) and OC stage I-II, III, IV were higher compared with the control (p1 = 0.031, p2 = 0.001, p3 = 0.0005, respectively). The Nph CCL2 level was higher in BT than in the control (p = 0.001). In stage I-II OC, the expression of CCL2 in Nph was higher than in the control (p = 0.034), but lower than in the BT (p = 0.003). In OC stages III and IV, the Nph CCL2 level was higher than in the control, but did not differ from that in BT and stages I-II. In stage III OC, the CCL2 level in Nph negatively correlated with the serum IL-17A level (r = -0.405, p = 0.049). Conclusions: The pro-tumor polarization of circulating Nph is not IL-17A-dependent in patients with ovarian tumors. The patterns of the systemic immune response differ in benign ovarian tumors, early, and advanced ovarian cancer.[Table: see text]
Impact of universal health care on trends of incidence and mortality of cancers with screening recommendations in North America. A GLOBOCAN 2020 study.
Authors: Addula Mounika 
Published: June 2021

e18513 Background: Cancers with screening recommendations in general population include breast, colorectal, cervical and prostate cancers. Our study is aimed at comparing the current and future trends in incidence and mortality amongst two biggest countries in North America (United States of America and Canada) with and without universal health care. Methods: Incidence and mortality data, their trends were obtained from the GLOBOCAN 2020 database. Crude rate and age standardized rate (ASR) data on incidence and mortality was obtained to minimize population-based distribution errors. Age groups were divided as 20-40, 40-49, 50-65 and above 65. Current incidence, mortality and future trends were obtained for both USA and Canada and compared. Results: Breast cancer incidence is higher in USA in all age groups. Mortality in the age groups of 20-39 and 50-64 is comparable in Canada and USA with ASR of 9.6 (Canada), 9.5 (USA) 197.2 (Canada), 195 (USA) respectively. Future trends predict higher increase in incidence and mortality in Canada in age groups of 40-49 (I: Canada +22.5% USA +19.2%. M: Canada +22.8% USA +19.3%) above 65 (I: Canada +52.3% USA +40.8%. M: Canada +70.9%. USA +57.3%). In age group above 65 the mortality is significantly higher in USA compared to Canada (p=0.001). The incidence of colorectal cancer is higher in USA compared to Canada. The ASR mortality of above 65 age group is significantly higher in Canada (p=0.0009) (M: Canada: 835.6 USA: 713.9). Mortality trends for the 2040 year are higher in the age groups of 50-64 and above 65 in Canada (50-64 M: Canada: +25.9% USA: +21.2%) (above 65: M: Canada +70.9% USA: +57.3%). Prostate cancer has higher incidence in 50-64 age group. The mortality is higher in 40-49 age group. The predicted incidence for 2040 is also higher in Canada in above 65 age group (Canada +48.3%, USA: 39.9%). Similarly, mortality is higher in Canada for the above 65 age group (Canada: +112.7%, USA: +90.2%). Both USA and Canada have higher mortality for prostate cancer in age group 40-49 than 50-64. Cervical cancer incidence and mortality ASR are higher in USA for age groups of 20-39 and 40-49. For ages 50-64, while the incidence is higher in the USA, mortality is higher in Canada. For ages above 65 the mortality is significantly higher in Canada (p=0.0022) compared to USA. The predicted percentage change in 2040, incidence and mortality of age group 40-49 is higher compared to 50-64. Conclusions: Though both health care systems have screening recommendations for breast, CRC, prostate and cervical cancers, mortality appears to be higher compared to the world population suggesting need for improvement in screening access/awareness. Younger adults (20-39) and middle age adults (40-49) appear to be more vulnerable population and need for improvement in identifying high risk population.
Do you hear us? Elevating the voice of patients from Asia Pacific (AP) and Middle East (ME) in pharmaceutical research.
Authors: Rihani Julie , Abdelbaky Noha Mohamed Mahmoud , Gulabani Chandra Rekha , Patel Dexter , El Sayegh Rami , Park JungHo , Dinboeck Michaela , Aubel Dawn , Slader Cassandra Alice 
Published: June 2021

e18519 Background: Incorporating patient (pt) perspectives in the development of new therapies (from trial design to regulatory & reimbursement decisions) and providing pts with plain language summaries (PLS) of clinical trial results is increasingly important to minimise knowledge and experience disparities. One model to facilitate this in pharmaceutical research is via Patient Expert Panels (PEPs). Aim: To assess the feasibility & impact of PEPs consisting of members from AP&ME on the development of 1. PLS of data presented at ESMO and ASH 2020 for selected Novartis-sponsored clinical trials 2. Disease education material for sickle cell disease (SCD). Methods: Thematic analysis of meeting minutes from PEPs conducted between Sep – Dec 2020 was performed. Data relating to meeting duration were extracted. The responses from an 8-item survey of PEP members were analysed descriptively for 6 items, thematically for 2. Results: Five virtual PEPs were conducted, with a median duration of 60 mins [range 60-120]. In total, 9 PLS were reviewed (8 breast cancer, 1 CML) & 1 SCD education booklet. Five common themes emerged regarding the input & impact of the PEP [Table]. 88% panelists responded they “Definitely will” participate in future PEPs, thereby confirming their feasibility, with the following quote being representative of the panelists’ experience & impact “I appreciated how our input as patients was valued and highly taken into consideration. It felt like our time and feedback was important to everyone.” Conclusions: PEP constituted of pts from countries in AP&ME are feasible and lead to impactful improvements in the development of PLS and disease education information. Given pt advocates in these countries are volunteers from organisations with limited resources, have diverse backgrounds in terms of culture, language & disease awareness, their input is more representative of a broader pt population. As a result, the final versions of the reviewed documents were more inclusive & accessible. [Table: see text]
Epithelial ovarian cancer survival by race/ethnicity in an equal-access healthcare population.
Authors: Arter Zhaohui Liao , Desmond Daniel , Berenberg Jeffrey L. , Merritt Melissa A. 
Published: June 2021

e18525 Background: Previous studies in the general population have observed that compared with Non-Hispanic White (NHW) women, Pacific Islander (PI) and Non-Hispanic Black (NHB) women have higher age-adjusted mortality rates from epithelial ovarian cancer (EOC), while Asian Americans (AS) have lower mortality. It is unknown whether these patterns reflect biological differences, environmental exposure or perhaps access to care. Our objective was to investigate whether self-reported race/ethnicity is associated with differences in EOC survival in a Military population where patients have equal access to healthcare. Methods: The study population included women diagnosed with EOC (ovarian, fallopian tube and primary peritoneal cancers) among US Department of Defense beneficiaries reported in the Automated Central Tumor Registry Database (year of diagnosis range: 2001-18). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models following participants from their date of diagnosis until last contact or censoring, whichever occurred first. Multivariable models were adjusted for covariates selected a priori because of their known influence on risk of EOC death; age at diagnosis (continuous), histology, stage and receipt of the first course of chemotherapy treatment. We adjusted for year of diagnosis (continuous) to account for possible changes in treatment over time. Results: The study population included 1151 patients diagnosed with EOC: 796 NHW, 111 NHB, 130 AS, 49 PI and 65 Hispanic (HS). All EOC patients had complete information on age at diagnosis, stage and chemotherapy treatment. During a median (interquartile range) follow-up of 3.5 years (1.8-6.7), 702 EOC patients (61%) died of all causes. When comparing crude EOC patient characteristics by racial/ethnic group, NHW had the highest frequency of EOC leading to death (58% vs. < 49% in other groups). There also were differences in histology; NHW and NHB had a higher frequency of serous tumors ( > 56% of EOCs vs. < 52% in other groups); PI had a high proportion of endometrioid histology (14% of EOCs vs. < 11% in others); 10% of EOCs among AS had clear cell histology (vs. < 9% in others). HS had a high percentage of local disease (23% vs. < 20% in others). In multivariable survival analysis adjusting for clinical factors, we observed that compared with NHW, there were no differences in EOC survival by race/ethnicity: AS, HR = 0.80 (95% CI = 0.61-1.05); NHB, HR = 0.96 (95% CI = 0.72-1.28); PI, HR = 0.92 (95% CI = 0.58-1.46); and HS, HR = 0.82 (95% CI = 0.56-1.21). Conclusions: We observed no racial/ethnic disparities in EOC survival in a Military equal access treatment environment. These results highlight the importance of studying how differences in access to healthcare may impact observed racial/ethnic disparities for EOC.
Measuring the impact and sustainability of a statewide program for identifying minority and underserved clients at risk for hereditary breast and ovarian cancer (HBOC): An eight-year follow up including transitions during the COVID pandemic.
Authors: Kerber Alice S. , Gabram Sheryl G. A. , Durrence Diane , Shin Janet Y. , Paris Nancy M. , Durham Lynn M. 
Published: June 2021

e18546 Background: The Georgia Breast Cancer Genomics Program was created with 2011-2014 funding from the Centers for Disease Control and Prevention and the Georgia Department of Public Health (GDPH). In collaboration with GDPH and the Georgia Center for Oncology Research and Education (Georgia CORE), the goal of the program has been to reduce disparities among high-risk minority and underserved women. The objective of this study is to report the 8-year surveillance data for women at increased risk for HBOC in statewide public health centers. The effect of the COVID pandemic on the program and sustainability is also reported. Methods: From 11/1/2012-12/31/2020, the program provided education, outreach and collected surveillance data using an online genetics referral screening tool as recommended by USPSTF. Providers in 159 counties and health centers across Georgia were educated in cancer family history collection and appropriate referral to genetics. When an individual was found to be at high risk, she was referred to the Georgia CORE Genetics Advanced Practice Nurse for additional education, genetic testing and follow-up. Results: Online screenings attributable to GDPH totaled 29,087 with 1,656 positive screens. 28 % of clients were less than 25 years of age and 56 % ranged from 25-54. Race: 33 % white, 41 % black, 15 % Hispanic and 11 % other or N/A. 92 % of referrals were uninsured. Genetic testing was started or completed on 430 clients. 36 individuals declined testing after counseling (reconsideration, insurance, unknown reasons) and were provided with contact information. 47 (11%) pathogenic, clinically significant mutations were identified including 37 (79 %) HBOC related mutations and 10 (21 %) Lynch related mutations. Variants of uncertain significance were identified in 90 (21 %) clients, with multiple variants in 40 of those. 27 clients have been served through GDPH for physician consultation and surveillance. 13 were referred to area resources: one diagnosed with cancer, and 7 chose referral to other health care providers. Because of the pandemic, the program transitioned to telecommunications and remote access to testing in 5/2020. From 5/2020-12/2020, 34 clients completed testing (41% minority, all uninsured). 10 (29%) clinically significant mutations were identified and heightened surveillance initiated. Conclusions: The GDPH and Georgia CORE collaborative genomics program has served clients over the past 8 years, adjusting to changing resources while reaching a significant number of minority and underserved women. The program successfully converted to remote services during the COVID pandemic. Lessons learned from this transition have been incorporated into planning for future program sustainability.
Impact of race and socioeconomic status on breast cancer outcomes within the AJCC staging system.
Authors: Kantor Olga , Wang Monica L. , Bertrand Kimberly , Chavez-MacGregor Mariana , Freedman Rachel A. , Pierce Lori J. , King Tari A. , Mittendorf Elizabeth A. 
Published: June 2021

e18565 Background: The persistent racial and socioeconomic status (SES) disparities in breast cancer outcomes are partially attributed to propensity towards more aggressive cancers or presentation at higher stages among these groups. Chronic stressors related to race and SES are another major mechanism underlying these inequities. This study aims to examine the effect of race and SES within the AJCC 8th-edition staging system, which incorporates anatomic extent of disease and tumor biology. Methods: The SEER breast cancer database linked with county-level census data was used to identify patients with invasive breast cancer from 2010-2015. The database includes a composite SES-index which was analyzed in quintiles. Cox proportional-hazards regression was used to estimate disease-specific survival (DSS). Results: 259,852 patients were included: 176,369 (67.9%) non-Hispanic white, 28,510 (11.0%) Black, 29,737 (11.4%) Hispanic, and 22,887 (8.8%) Asian. Black race, lower SES, public insurance, lower education, and increased poverty were associated with decreased DSS. Adjusted survival analysis for patient, SES, tumor, and treatment characteristics demonstrated that patients of black race had inferior DSS within each stage. Fully adjusted models also showed patients residing in lower SES counties had inferior DSS [Table]. Conclusions: Racial and SES disparities in breast cancer-specific mortality were evident across all stages of disease. Future efforts to improve breast cancer outcomes should systematically assess and address racial and socioeconomic factors as fundamental drivers of inequitable outcomes. Adjusted 5-year DSS Estimates, Stratified by Race and SES.[Table: see text]
Mammography screening disparities in Asian American women: Findings from the California Health Interview Survey 2015-2016.
Authors: Li Yannan , Xie Hui , Theodoropoulos Nicholas , Wang Qian 
Published: June 2021

e18568 Background: Foreign-born Asians were less likely to utilize preventive care due to medicine beliefs, language barriers, insurance coverage, and more. Their perceptions of breast cancer risks and screening benefits for asymptomatic conditions may differ from individuals born in the United States. It is urgent for preventive health professionals to understand screening disparities in Asian Americans. Methods: Data from the California Health Interview Survey (CHIS) 2015-2016 were used. Multivariable adjusted logistic regressions were generalized to identify the up-to-date mammography screening in relation to socioeconomic, chronic health condition/health behavior, and preventive care utilization, stratified by race. Results: Of NH-White and Asian American women aged 40 and above (unweighted N = 13,451), 78.41% were NH-White, 25.38% were foreign-born, 56.88% spoke only English at home, and 6.44% were not currently insured. The prevalence for self-reported mammography screening in NH-White and Asian American women were 68.06% and 65.97%, respectively. Among Asian American women, the lowest rate of mammograms was in Koreans (55.29%) and Chinese (72.19%) had the highest rate (p = 0.6438). In NH-White women, place of birth, smoking status, borderline diabetes, high blood pressure, is currently insured, and having a preventive care visit in the past 12 months were significant factors. Within Asian American women, borderline hypertension and having a preventive care visit were significant factors, but not ethnicity. Conclusions: The findings indicate that mammogram disparity in relation to socioeconomics, health behaviors, preventive care utilization, and race. Further development of ethnic-specific cancer prevention strategies and policies that address the subgroup differences within the larger racial/ethnic population are needed. Public health outreach and cancer education should target Asian American women with borderline hypertension and no preventive care visits.
The timeliness of lung cancer care: A systematic review of systematic/scoping reviews on time intervals and their impacts on cancer outcomes.
Authors: Zhang Jianrong , Oberoi Jasmeen , Karnchanachari Napin , Druce Paige , IJzerman Maarten J. , Emery Jon D. 
Published: June 2021

e18572 Background: Lung cancer is characterized by the aggressive nature and lack of early noticeable symptoms, highlighting the importance of timely care for lung cancer. This systematic review of systematic and scoping reviews provides the summary of review-level results related to the length of time intervals and the impact of these intervals on oncological outcomes. Methods: Eligible articles included published systematic or scoping reviews and meta-analyses that used systematic searching to investigate the length of time intervals and their impact on patient survival and disease stage at diagnosis in original studies on lung cancer, based on at least one interval involving the date of diagnosis as the start/endpoint. Articles were searched via PubMed, Embase, Web of Science, and the Cochrane Library (date range: from database inception to 6 August 2020) (PROSPERO identifier: CRD42020203530). Results: From 1395 identified publications, we included a total of 8 systematic/scoping reviews published in 2002-2018 (7 on length of intervals, 5 on survival/stage impact). For the length of intervals, these reviews found that intervals across countries/medical facilities are heterogeneous and often longer than recommended by guidelines. For the survival/stage impact, the results from these reviews indicated mixed (positive, negative, or no) associations between time intervals and patient survival/disease stage at diagnosis. We further summarized study-level results and confirmed the finding of mixed associations based on 36 eligible original studies from over 100 studies included in these reviews. Methodologically, review authors pointed out large variations in time intervals (96 unique variations) and methods used to measure intervals. Based on the reviews, we found that the intervals in studies were normally investigated cross-sectionally, rather than temporarily (to demonstrate the trend of intervals’ length over time). Conclusions: Current evidence indicates that patients with lung cancer may experience diagnosis and treatment delays, however, the association results between the length of intervals and lung cancer survival and stage are paradoxical. To minimize avoidable delays, future studies should keep updating the length of intervals and provide the trend analysis of the intervals over time, as part of cancer surveillance to guide future policy making and clinical practice. To improve the quality of future original studies and systematic reviews, specific guidelines and corresponding studies related to study design and methodology (e.g. types of time intervals, measures of time intervals, statistical analysis strategy) are warranted, especially underscoring the effect of “waiting time paradox” when investigating the impact of time intervals on patient outcomes.