bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of COVID19 pandemic on treatment outcome of locally-advanced head and neck squamous cell carcinoma (LA-HNSCC): IMPACCT study.
Authors: Guillen Sentis Pau , Castillo Manzano Carmen , Quirós Beatriz , Morey Cortes Francisca , Tous Sara , Plana Maria , Brenes Castro Jesús , Lozano Alicia , Linares Isabel , Vilajosana Altamis M. Esther , Gomez Garcia Victoria , Labori Trias Maria , Goma Montse , Mari Roig Antonio , Bermejo Oriol , Tornero Salto Jordi , Taberna Miren , Alemany Laia , Mesia Ricard , Oliva Bernal Marc 
Published: June 2021

6061 Background: Treatment (ttm) of cancer patients (pts) was compromised during the first wave of COVID19 pandemic due to collapse of healthcare systems. Standard of care (SOC) for LA-HNSCC pts had to be adapted as operating rooms were temporarily unavailable, and to reduce risk of COVID19 exposure. The IMPACCT study evaluated the outcome of LA-HNSCC pts treated at the Catalan Institute of Oncology during the first semester of 2020 and compared it to a control cohort previously treated in the same institution. Methods: Retrospective single institution analysis of two consecutively-treated cohorts of newly-diagnosed HNSCC pts: from January to June of 2020 (CT20) and same period of 2018 and 2019 (CT18-19). Pt demographics and disease characteristics were obtained from our in-site prospective database. Ttm modifications from SOC as per COVID19-contingency protocol in CT20 for LA-HNSCC were collected. Chi-squared was used to compare variables and ttm response between cohorts. One-year recurrence-free survival (1yRFS) and overall survival (1yOS) of LA-HNSCC pts were estimated by Kaplan-Meier method and compared by Log-rank test. Results: A total of 306 pts were included: CT20=99; CT18-19=207. Baseline characteristics were balanced between cohorts (Table1). In pts treated with conservative ttm (non-surgical approach), persistence disease was higher in CT20 vs CT18-19 (26 vs. 10% p=0.02). Median follow-up of CT20 and CT18-19 was 6.8 months (IQR 5.1-7.9) and 12.3 (6.7-18.4), respectively. A trend towards lower 1yRFS and 1yOS was observed in CT20 vs CT18-19 (72 vs 83% p=0.06; 80 vs 84% p=0.07), respectively. Within CT20, 37 pts (37%) had one or more ttm modifications: switch from surgery to conservative ttm (n=13); altered radiotherapy fractionation (n=14); reduced cisplatin cumulative dose to 200mg/m2 (n=19); no adjuvant ttm (n=1). Pts who received modified ttm had no differences in 1yRFS vs those who did not (80 vs 66% p=0.31), but higher 1yOS was observed (97 vs 67% p<0.01). When stratified by stage, 1yOS difference remained significant in stage III/IVA (100 vs 61% p<0.01) but not in I/II (100 vs 77% p=0.28) or IVB (67 vs 50% p=0.54). Conclusions: COVID19 pandemic had a negative impact on ttm outcomes and survival in LA-HNSCC pts when compared to our historical cohort. Ttm modifications based on COVID19-contingency protocol did not compromise ttm efficacy in terms of RFS and was associated with better OS in Stage III/IVA.[Table: see text]
Predictive and prognostic biomarker identification in a large cohort of androgen receptor-positive salivary duct carcinoma patients scheduled for combined androgen blockade.
Authors: Lassche Gerben , Tada Yuichiro , Van Herpen Carla M.L.- , Jonker Marianne A. , Keizer Diederick , Verhaegh Wim , Nagao Toshitaka , Saotome Takashi , Hirai Hideaki , Saigusa Natsuki , van Engen - van Grunsven Adriana C.H. , Schalken Jack A. , Fushimi Chihiro , Verhaegh Gerald W. 
Published: June 2021

6071 Background: Patients suffering from recurrent or metastatic (R/M) salivary duct carcinoma (SDC) are often treated with combined androgen blockade (CAB). This treatment however frequently fails (response rates: 18-53%), resulting in a worse prognosis. Therefore, biomarkers that have prognostic value and can predict treatment response are urgently needed. Methods: mRNA from 77 R/M androgen receptor (AR) positive SDC patients treated with leuprorelin acetate combined with bicalutamide was extracted from pre-treatment tumor specimens. AR, Notch, Mitogen-Activated Protein Kinase (MAPK), Transforming Growth Factor beta (TGFβ), Estrogen Receptor (ER), Hedgehog (HH) and the Phosphoinositide 3-Kinase (PI3K) signaling pathway activities were calculated based on expression levels of relevant target genes. Besides this, 5-alpha reductase type 1 ( SRD5A1) expression and Human Epidermal growth factor Receptor 2 (HER2) status were determined. Clinical benefit was defined as complete or partial response or stable disease ≥6 months. Results: Of the 7 signaling pathways, AR pathway activity was the best predictor of clinical benefit (AUC 0.67, 95%-CI 0.54-0.80). At a threshold of 47.8, 21% of the patients tested negative, with a negative predictive value of 93%. SRD5A1 expression outperformed the signaling pathways regarding predictive value (AUC 0.78, 95%-CI 0.67-0.88). Fitting of a multivariable model led to the identification of SRD5A1, Notch and TGFβ as most predictive combination (AUC 0.82, 95%-CI 0.72-0.91). AR, Notch, HH and SRD5A1 were also of prognostic importance regarding progression free survival and SRD5A1 expression levels also for overall survival (median of 175.0 weeks for high versus 96.7 weeks for low expression). Conclusions: Our study revealed predictive and/or prognostic value of AR, HH, Notch and TGFβ signaling activities and SRD5A1 expression in SDC patients treated with CAB. AR pathway activity can be used for identifying non-responders. Further clinical validation is required before implementation of these biomarkers in clinical practice. The observed role of SRD5A1 expression in CAB response forms a rational basis for including SRD5A1-inhibitors in the treatment of SDC patients.[Table: see text]
Reducing racial disparities in time to breast cancer diagnosis: Impact of immediate screening mammogram reads during the COVID pandemic.
Authors: Achibiri Janeiro , Dontchos Brian Nicholas , Mercaldo Sarah , Narayan Anand , Miles Randy C. , Lamb Leslie , Wang Gary X. , Lehman Constance Dobbins 
Published: June 2021

6508 Background: During the COVID-19 pandemic, barriers to access screening mammography along with goals to reduce visits supported immediate reading of screening mammograms. Typically, screening mammograms are reported after patients have left the facility. If imaging is abnormal, then an additional visit is needed for diagnostic imaging, introducing delays and potential disparities .Thus, we implemented an immediate-read screening mammography program and measured its impact on racial/ethnic disparities in time to diagnostic imaging after an abnormal screening mammogram. Methods: Responding to the COVID-19 pandemic, we implemented an immediate read screening program in late May 2020. Patients were provided imaging results before discharge and if the exam was abnormal, efforts were made to perform diagnostic imaging during that visit. We identified consecutive screening mammograms performed weekdays 8:00am-4:30pm and Saturdays 9:00am-4:00pm pre-implementation (6/1/19-10/31/19) and post-implementation (6/1/2020-10/31/2020). Exams left unread while awaiting comparison studies, due to technical factors, or for more than 10 days were excluded. Patient demographics and time from screening exam completion to report finalized were obtained from the electronic medical record. Cancer detection rate (CDR), abnormal interpretation rate (AIR), and positive predictive value (PPV) were calculated. Multivariable linear and logistic regression models were used to compare time from screening exam to report, same-day diagnostic imaging, and screening performance metrics pre- and post-implementation overall and by patient subgroups. Results: After 963 exams met exclusion criteria, a total of 8,222 pre- and 7,235 post-implementation exams were included. Median time to report finalization decreased from 61minutes (interquartile range [IQR]:24, 152) to 4 minutes (IQR:2, 7) for pre- and post-implementation periods (p < 0.001). During the pre-implementation period, non-white patients had lower odds of having same-day diagnostic imaging after an abnormal screening exam (age-adjusted odds ratio: 0.28; 95% CI: 0.10, 0.78 p = 0.015). There was no evidence of this disparity post-implementation. AIR was higher in the pre- versus post-implementation period (6.3% versus 5.0%; p < 0.001). There was no evidence of a difference in CDR (5.8 versus 4.2 cancers/1,000 exams) and PPV (9.2% versus 8.4%) for pre- versus post-implementation periods. Conclusions: An immediate read screening mammography program reduces racial/ethnic disparities in time to diagnostic imaging after an abnormal screening mammogram, thus promoting equity in access to care.[Table: see text]
Racial and ethnic representation trends in United States oncology training programs.
Authors: Lombardi Conner , Lang Jacob , Issa Rochell , Ukaegbu Oke Oluchi , Reddy Krishna , Ekwenna Obi 
Published: June 2021

6519 Background: Utilizing race and ethnicity data from the Accreditation Council for Graduate Medical Education (ACGME), this study aims to assess representation trends across American Society of Clinical Oncology (ASCO) participant specialties from the past five academic years in order to characterize current needs and effectively address these needs moving forward. Methods: Self-reported ethnicity/race data from the ACGME database books were collected from academic years 2015-16 to 2019-2020 for the following oncologic training programs: hematology and medical oncology, medical oncology, gynecologic oncology, pediatric hematology and oncology, radiation oncology, complex general surgical oncology. Summary statistics and chi-square analysis were conducted to compare underrepresented minority (URM) trends across programs. URM groups were cross-referenced with definitions provided by the AAMC and included those who identify as Hispanic, Latino or of Spanish origin, Black or African American, and Native American or Alaskan. Results: Over the study period, only 1,250 (9.0%) of 13,853 oncology trainees identified as URM. Chi-square analysis demonstrated no significant change in URM representation in all oncology specialties combined between 2015-16 and 2019-20 (8.9% [95% CI, 7.8%-10.0%] vs. 9.7% [95% CI, 8.7%-10.8%]; P=.31). Between 2015-16 and 2019-20, Hematology and oncology (+1.3%), pediatric hematology and oncology (+0.3%) all demonstrated insignificant increasing trends in representation while radiation oncology (-0.3%), complex general surgical oncology (-4.0%) had statistically insignificant decreasing trends in representation. Gynecologic oncology (+6.0%) demonstrated a significant increasing trend in representation. Conclusions: This is the first study to characterize the vast disparities in representation in oncologic training programs in the United States. There is a demonstrated lack of representation across all oncology training programs and a lack of significant improvement over the study period. A multiprong approach is needed to improve diversity and representation across the spectrum of the oncology workforce in the United States.
Investigating tumor molecular profiling as a possible contributor to racial/ethnic disparities in pancreatic cancer.
Authors: Walker Evan Justin , Piawah Sorbarikor , Griffin Ann , Carnevale Julia C. , Cinar Pelin , Collisson Eric Andrew , Tempero Margaret A. , Ko Andrew H. 
Published: June 2021

6522 Background: A variety of biologic, socioeconomic, and treatment-related factors may contribute to the racial/ethnic disparities observed in pancreatic ductal adenocarcinoma (PDAC) outcomes. As tumor molecular profiling (TMP) is now recommended for patients (pts) with advanced PDAC to inform treatment selection, we hypothesized that rates of TMP, detection of actionable alterations (AA), and use of molecularly-targeted treatments differ across different racial/ethnic groups and may contribute to disparate outcomes. Methods: This retrospective analysis included all Non-Hispanic White (NWH), Asian, Hispanic/Latinx (H/L), and Black/African American (B/AfrAm) pts with PDAC who underwent TMP at UCSF over a 4-yr period. Medical records were reviewed for demographic and disease-specific data. Alterations classified as ‘pathogenic’ or ‘likely pathogenic’ in TMP clinical reports were included, and were categorized as ‘actionable’ if there was clinical or preclinical evidence of benefit from targeted therapy in any cancer. Associations between NHW and other groups were tested with Fishers exact test. Results: Between 1/2016-1/2020, 159/727 (22%) pts underwent PDAC TMP. 60 AA were detected in 54 pts. Rates of TMP or AA detection were not associated with racial/ethnic group (Table). Most AA (33/60, 55%) were associated with the Homologous Recombination DNA Damage Repair (HR-DDR) pathway ( ARID1A n = 15 , ATM n = 7 , and BRCA1 n = 5). Other common AA included PIK3CA alterations (n = 6), CDK4/6 amplifications (n = 5), AKT2 amplifications (n = 4) and KRAS G12C mutation (n = 4). Molecular targets differed between groups (HR-DDR genes comprised 55% AA in NHW vs 100% in H/L, p = 0.03). Regarding treatment, rates of platinum chemotherapy for HR-DDR gene-altered PDAC differed significantly between groups. Three NHW pts with HR-DDR alterations received a PARP-inhibitor +/- ATR inhibitor. Conclusions: To our knowledge, this is the first study to report PDAC TMP rates and therapeutic implications across racial/ethnic groups. Acknowledging the limitations of sample size and what defines AA, we observed no significant differences in rates of testing nor AA detection. Further study is needed to evaluate whether rates of molecularly-informed treatment selection contribute to racial/ethnic disparities in clinical outcomes. As therapeutic advances increase the likelihood of identifying AA, equitable access to both TMP and targeted treatments must be ensured for all pts with PDAC.[Table: see text]
Uptake of immunotherapy in patients with advanced cancer: A population-based study using health administrative data from Ontario, Canada.
Authors: Raphael Jacques , Richard Lucie , Lam Melody , Blanchette Phillip S. , Leighl Natasha B. , Rodrigues George , Trudeau Maureen E. , Krzyzanowska Monika K. 
Published: June 2021

6529 Background: The introduction of immunotherapy (IO) in the treatment of patients with cancer has significantly improved clinical outcomes. Herein we report on IO uptake in Ontario, Canada, a publicly funded healthcare system. Methods: We conducted a retrospective cohort study using provincial health administrative data to: 1) assess IO uptake in adult patients with advanced melanoma, bladder, lung, head and neck (HN) and kidney cancers; and 2) identify predictors of IO usage between 2011 (pre-IO funding) and 2019. The datasets were linked using unique encoded identifiers and analyzed at ICES. IO uptake was captured between cancer diagnosis and last follow up and reported as a proportion of the entire cohort and by tumor site and drug type. A competing risk Fine and Gray regression model with death as competing risk was used to identify factors associated with IO use. Results: Among 59,510 patients with one of the five advanced cancers of interest, 7,660 (12.9%) received IO. Details of IO uptake are summarized in Table. IO uptake increased yearly from 2011 (2.7%) to 2019 (34.0%). Uptake was highest in melanoma (48.2%) and lowest in HN cancer (5.8%). The most commonly used drugs used were pembrolizumab (41.1%) and nivolumab (40.5%). In adjusted analysis, predictors of lower IO uptake included older age (hazard ratio (HR) 0.953, 95%CI 0.934-0.972 with every additional 10 years), female sex (HR 0.859, 95%CI 0.819-0.9), lower income quintile (HR 0.893, 95%CI 0.83-0.96), history of hospital admission (HR 0.768, 95%CI 0.734-0.805), female oncologist (HR 0.942, 95%CI 0.892-0.995), and de novo stage 4 cancer (HR 0.918, 95%CI 0.873-0.966). Predictors of higher IO uptake were low Charlson score (HR 1.118, 95%CI 1.01-1.236) and previous radiation therapy (HR 1.438, 95%CI 1.367-1.512). IO uptake was heterogeneous across cancer centres levels (1 to 4) and regions. Conclusions: While the use of IO for advanced cancer has steadily increased over time, uptake is associated with patient and physician characteristics, as well as system level factors. This variation suggests potential inequity in access to these potentially life-prolonging drugs and should be further investigated and addressed.[Table: see text]
Process redesign and daily management to improve cancer care access at the public healthcare system in Sao Jose dos Campos, Brazil.
Authors: Pinto Carlos Frederico , Stanzani Danilo , Pontes Elitania , Coelho Stela Maris , Correa Margarete , Benjamin Joana , Silva Messias Borges 
Published: June 2021

6530 Background: Cancer is the second leading cause of death in Sao Jose dos Campos (SJC, a mid-sized city with 720,000 hab. in Sao Paulo state, Brazil) and the most relevant budget in tertiary care. The City Healthcare Authority created in October 2018 a team to manage and provide more effective and efficient cancer care and access to the public healthcare system by using process redesign and daily management tools (Previna Project). The aim was to guarantee access to cancer specialist and care up to 60 days form diagnosis, understanding that this can impact in cancer morbidity, mortality, and cost. Methods: The Previna was grounded in 4 major actions: (1) process redesign (2) escalated daily management system, (3) improve communication channels to all providers connecting primary care to specialized care, (4) and emergency access. (1) Process Redesign involved connecting and linking access to several providers and eliminating unnecessary steps or repeated orders in the system, it also involved alerts into the system for specific conditions like elevated PSA or CEA; positive fecal occult blood test; BIRADS 4-5 mammogram; abnormal PAP smears; and new screening protocols for prostate and colorectal cancer. (2) Daily Management involved internal daily discussions about capacity and review of system alerts or demands. Weekly discussions on specialized procedures including imaging, biopsies, chemo, radiation or surgery flows; and biweekly meetings with all providers (3 hospitals and 4 specialized practices). (3) Communication channels improvements involved a hotline to access flow managers for primary and secondary care units, specialist’s consultancy by phone, and (4) emergency access provided for units with special needs or urgent care requirements. All actions were connected by flow managers using alert systems, visual boards, kanban and similar tools to manage daily progress. Results: The access to cancer care and treatment up to 60 days improved from 2017 to 2020 almost two-fold with the Previna (Table). Cancer diagnosis also increased substantially, and it is expected to be related to previous periods underdiagnosed patients. Flow redesign also reduced median time to process Her2, ER and PR for breast cancer from 38 days in 2018 to 9 days in 2019 and 4 days in 2020, positively impacting treatment decisions. The hotline access reviewed and answered 2,389 demands from care providers between 2018 and 2020. Access to Cancer Care for ICD C00 – C97 (excl. C44 and C73) in SJC. Conclusions: The combined use of daily management, lean tools and flow redesign in the Previna was able to improve access and anticipate cancer diagnosis in a public healthcare system using simple and low-cost initiatives.[Table: see text]
High incidence of concurrent disease states detected during mobile lung cancer screening in an underserved population.
Authors: Carrizosa Daniel R. , Doege Darcy L. , Wheeler Mellisa S , Dungan Kia , Davis Lauren , Hickman Glenn , Weatherford Brooke , White Stephanie , Doty John D. , Mileham Kathryn Finch , Raghavan Derek 
Published: June 2021

6540 Background: Studies such as the National Lung Screening Trial (NLST; N Engl J Med 2011;365:395-409) have shown a survival benefit to low-dose Lung CT screening in high-risk smokers. Levine Cancer Institute (LCI) initiated the first mobile low dose computerized tomographic (LDCT) lung screening program for underserved populations in 2017. In addition to being able to intervene early in the natural history of lung cancer, the project has also shown a previously unreported high incidence of incidental diseases in this population. We characterize these findings in 1198 patients. Methods: From May 2017, subjects with criteria eligible for NLST screening were identified and underwent LDCT for lung cancer detection. Patients screened in the program were all uninsured or underinsured, mean age 60.8 years, 18% were African American, 3% Latin-x and 78% were rural with an overall 47.1 mean pack-year smoking history. These patients were screened using a novel mobile LDCT (J Clin Oncol 37, 2019 suppl; abstr 6567) created for this program. By December 2020, 1198 patients completed their first screening. All CT scans were reviewed by two separate radiologists and were reviewed for quality assurance by a separate expert multidisciplinary team. Results: Of the 1198 subjects, 84% (1006 subjects) were found by LDCT to have a least one incidental disease. More than half of the subjects (645, 53.8%) had coronary atherosclerosis. Of those, 25% (183) were described to have at least moderate disease with 8% (96) described as severe. Overall, 42% (504) were found to have emphysema and 25% (299) had vascular atherosclerotic disease; 1.8% (22) of those screened had a detected aortic aneurysm. In total, thirty separate disease findings were found (listed from fourth to tenth most common finding: degenerative spine changes [205], cholelithiasis [59], hiatal hernia [52], pericardial effusions [38], fatty liver [32], kidney stone [3]), and cardiomegaly [30]). 3.5% (42) were found to have an undiscovered breast, adrenal, liver or kidney mass that required further workup. Conclusions: The number of incidental findings in our mainly rural underserved subject group was very high (84%). 35.5% of patients in the National Lung Screening Trial died from heart disease or respiratory disease. These numbers have not been overtly discussed and our study confirms the number of concerning incidental diseases that can lead to morbidity or mortality. In this high-risk, underserved population of heavy smokers, the opportunity for positive impact on other disease states can be increased by a mobile lung cancer screening program by increasing access to care.