bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mutational profiles of ovarian cancer in Chinese patients revealed potential therapeutic targets and prognostic markers.
Authors: Feng Weiwei , Lyu Tianjiao , Liu Hua , Jiang Yahui , Shen Lifei , Long Wenqing , Zhu Lan , Shao Siqi , Ma Jinyan , Wang Jian , Zhou Yuxi , Yang Yuchen 
Published: June 2021

e17525 Background: Ovarian cancer (OC) is a common and lethal gynecologic malignancy. The prognosis of OC is variable among different patients treated with standard of care therapies. Herein, we described mutational profiles of OC to identify underlying therapeutic targets and prognostic markers. Methods: The study was performed in 38 Chinese patients with high-grade serous ovarian cancer (HGSC), the most common subtype of OC. Most patients (86.8%) had advanced disease (stage III-IV). Tissue samples were subjected to capture-based targeted sequencing using a panel consisting of 520 cancer related genes. Mutational profiles including gene mutations and copy number variations (CNVs) were evaluated in each patient. Homologous recombination deficiency (HRD) status was also assessed. Analysis of mutational profile with platinum-sensitivity, progression-free survival (PFS) and platinum-free interval (PFI) were performed. Results: Genetic alterations were mainly identified in TP53 (97%), BRCA1 (24%), RB1 (21%), FGF23 (21%), CCND2 (18%), RECQL4 (18%) and NF1 (16%). CNVs were comprehensively distributed in 242 genes with 76% (29/38) of patients harboring at least one CNV. In addition to BRCA1, genetic alterations were also presented in other homologous recombination repair (HRR) genes including CDK12 (5%), BRCA2 (3%), ATM (3%), BRIP1 (3%), CHEK1 (3%) and FANCI (3%). There were 22 of 38 (58%) patients with genetic alterations of the HRR pathway. In the study, 28 patients were platinum-sensitive (74%) and 10 were platinum-resistant (26%). Platinum-sensitivity was significantly associated with BRCA1/2 mutations (p < 0.01). In platinum-resistant patients, 7 of 10 patients harbored genetic alterations of actionable therapeutic targets such as PIK3CA, TSC1 and HER2 alterations. The prognosis analysis indicated that BRCA1/2 mutations were significantly associated with improved PFI (p < 0.05) and marginally associated with improved PFS (p = 0.05). Although no association was observed between HRD status and patient prognosis, subgroup analysis in patients with R0 resection found positive HRD showing significant association with better PFI (p < 0.05) and marginal association with better PFS (p = 0.06). Further analysis of HRD classified by NF1 revealed different PFS and PFI among patients harboring positive HRD, negative HRD with NF1 mutations and negative HRD with wild type NF1 (p < 0.05). The study also observed association of LRP1B mutations and RAD52 amplification with worse PFS (p < 0.05). Conclusions: In OC patients, genetic mutations were frequently occurred in both HRR and non HRR genes. CNVs were widely presented in many genes and patients. The mutational profiling also identified a number of potential therapeutic targets and prognostic markers at molecular level which could contribute to personalized treatment and management of OC.
Outcomes of curative intent treatment in advanced gynecological cancer with recurrent, distant lymph node, or visceral organ metastasis: Retrospective study from a single community center.
Authors: Narayanamoorthy Sujatha , Wu Yunhong , Berlach David , Xu Yiqing 
Published: June 2021

e17566 Background: Uterine, cervical and ovarian cancers with isolated recurrences in the pelvic, para-aortic or distant lymph nodes, such as axillary, supraclavicular lymph node, or visceral organs, are uncommon conditions. The standard care is palliative systemic chemotherapy. We hypothesized that combined modality treatment (CMT) incorporating surgery or radiation for curative intent may increase local disease control and delay or mitigate further distant metastasis, thereby increase overall survival (OS). Methods: We retrospectively reviewed characteristics and outcomes of patients who had localized recurrence of gynecological malignancies and who were treated with an aggressive approach of salvage chemotherapy + radiation +/- surgery or radiofrequency ablation. Results: We identified 23 patients, including 6 cervical, 14 uterine and 3 ovarian cancer patients who were treated from 2005 to 2021. The mean age was 68. About 47.8% patients had advanced stages of disease at diagnosis (stage 3+4). Serous carcinoma (n = 7, 30.4%) was the most common uterine cancer pathology. All patients received curative intent therapy at initial diagnosis. The first recurrence sites are shown in the table, and the visceral organs involvement were liver, gluteal muscle, etc. The recurrence was within previous radiation field in 9 patients (39.1%) and outside radiation field in 12 (52.1%). 16 patients had local radiation + chemo, 6 had systemic chemo only and 1 had radiation only (see table below). Only 13 patients had a second recurrence, including 5 from the previous systemic treatment only group. Seven had local recurrence only and all received local therapy. Six patients eventually developed wide spread disease, and 2 died. After a median follow up of 56 months (range 22 to 186 months), 17 patients were alive (4 lost for follow up), and 15 had no evidence of disease (NED). The median time to first recurrence was 14.5 m [Interquartile range (IQR), Q1, Q3 to be 7, 19]. The PFS for those patients who had only 1 recurrence was 41.5 m (IQR 21, 63). The PFS for those who had the second recurrence until the next progression was 15 months (IQR 9, 37). The overall survival in all patients was 56 m (IQR 39, 71). Conclusions: A curative intent, salvage CMT protocol for advanced GYN cancer patients who develop isolated local or distant recurrence may have a therapeutic advantage. It renders a longer PFS and OS than those from systemic therapy alone reported in the historical data.[Table: see text]
Genomic characterization of p16+ compared to p16- HNSCC patients treated with immune checkpoint inhibitors and overall survival.
Authors: Shaikh Hira Ghazal , McGrath Julie Elaine , Xiu Joanne , Hughes Brittany Nicole , Sukari Ammar , Nabhan Chadi , Korn Wolfgang Michael , Darabi Sourat , Grover Punita , Chernock Rebecca , Ikpeazu Chukwuemeka , Wise-Draper Trisha Michel 
Published: June 2021

e18024 Background: Multiple studies investigating immune checkpoint inhibitors (ICI) in head and neck squamous cell cancer (HNSCC) patients have demonstrated prolonged survival of p16+ versus p16- tumors. However, the data has been conflicting. Methods: We queried the Caris Life Sciences CODEai database to assess survival outcomes of HNSCC patients who received ICIs comparing p16+ and p16- subgroups. A standard cut-off of 2+, >70% p16 staining was used. Presence of HPV16/18 genomes was tested using whole exome sequencing. Patients were considered smokers if they had >15 pack-years of tobacco use. PD-L1 expression was assessed by the 22c3 antibody, ≥1 being positive. Gene mutations were evaluated using Next-Generation Sequencing (NGS) (Caris Life Sciences, Phoenix, AZ). Tumor mutational burden (TMB) was assessed by somatic nonsynonymous missense mutations. Real world overall survival (rwOS) was obtained from insurance claims data and Kaplan-Meier estimates were calculated from the date of treatment start to the date of last contact. Time on treatment (TOT) was calculated from date of start to completion of ICIs. Results: 2905 patients with HNSCC were identified in the Caris database. 41% (215/525) were smokers. Among patients who were tested for p16 and/or HPV, 32% (251/791) expressed p16 and 28% (91/236) were HPV+. The majority of p16+ tumors were oropharynx (OP) in origin (68%, 171/251). 87% (970/1111) of tumors expressed PD-L1 and 16% (216/1362) had TMB ≥10/Mb. TP53 (54%, n=1115/2076) and CDKN2A (17%, n=281/1649) were the most common mutations. When compared to p16-, the p16+ group had a higher prevalence of TMB ≥10/Mb (26% vs 17%) and RB1 mutations (21% vs 4%) but lower number of smokers (15% vs 34%) and TP53 mutations (32% vs 58%). Similar to previous reports, p16+ oropharynx squamous cell carcinoma (OPSCC) patients survived longer than p16- patients, rwOS, 47 vs. 20 months (HR=0.55, p = 0.014) respectively. Among patients who were treated with ICIs, p16+ and p16- non-OP HNSCC, rwOS was not reached (NR) for both groups at follow up of 22 months while TOT for p16+ and p16- respectively, was 3.5 vs. 2.7 months, HR 0.507, p=0.039. No statistically significant difference was found in rwOS (19.3 vs. 24 months, HR 1.8, p=0.27) or TOT (3.7 vs. 4.1 months, HR 0.78, p=0.38) between p16+ and p16- OPSCC groups treated with ICIs, respectively. Conclusions: P16+ non-OP HNSCC patients receiving ICIs were found to remain on treatment longer compared to p16- patients which was not reproduced in the OPSCC subgroup. Randomized controlled trials are needed to verify p16 as a prognostic marker for ICI therapy.[Table: see text]
Dissemination of validated health literacy videos: A tailored approach.
Authors: Blee Shannon M. , Dixon Margie D. , Master Viraj A. , Pentz Rebecca D. 
Published: June 2021

e18505 Background: Previously, we showed that chemotherapy and precision medicine terminology are remarkably difficult for patients to understand. Therefore, we developed short, animated videos explaining key terminology and demonstrated that they significantly improved understanding. These videos, though effective and published, including freely downloadable, will only be helpful if appropriately disseminated. In the past, even after a video-based educational tool for prostate cancer was proven effective for improving patient comprehension, no dissemination plan was implemented due to copyright issues. Therefore, in order to propel these validated health literacy videos from the academic community into clinic workflow, we aimed to determine the best dissemination method at two different hospitals with disparate populations just six miles apart: an underserved, inner-city hospital and a higher SES hospital. Methods: The dissemination interview was developed in collaboration with an expert Intervention Development, Dissemination, and Implementation team. The draft was cognitively tested with physicians and staff who were not oncologists and finalized. With consent, interviews were conducted with both Winship Cancer Institute and Grady Memorial Hospital providers (GMH). All interviews were audio recorded, transcribed and analyzed using a semantic content analysis method. Results: Eleven providers at GMH and 22 providers at Winship were interviewed, reaching saturation of themes. 72% (n = 8) of the GMH providers felt that the best place for patients to view the videos was in the clinic, compared to 27% (n = 6) of the Winship providers. 68% (n = 15) of the Winship providers stated an app would be the most useful format, compared to 27% (n = 3) at GMH. All agreed that it would be useful for the patient’s family or caregiver to view the videos (GMH = 100%, Winship = 72%), that translation of the videos to Spanish would be beneficial (GMH = 90%, Winship = 63%), and that a nurse would be best to introduce the videos (GMH = 81%, Winship = 68%). Conclusions: Educational materials explaining complicated oncology treatment terminology enhance patient-centered care, yet without proper dissemination these crucial educational tools may never reach the intended patient population. The hospitals examined in this study served significantly different patient populations and the dissemination recommendations were quite different. Providers believed that the underserved patients needed the videos accessible in the clinic whereas providers serving higher SES patients thought that a web-based app, requiring a smart device or internet access, was more appropriate. Our study shows that it is crucial to ensure that educational materials are accessible to all populations, not just those with more means. Without a location-specific dissemination plan, educational tools may only further exacerbate disparities, rather than alleviate them.
Racial disparities and medical care accessibility in cancer statistics.
Authors: Soror Noha , Keruakous Amany 
Published: June 2021

e18510 Background: Cancer is one of the leading causes of death worldwide. It continues to be the second leading cause of death in the United States despite all national efforts aiming to reduce cancer burden and mortality. Delays in medical care and subsequently age-appropriate screening leads to increased cancer burden which reflect on the overall prognosis. Medical care accessibility has been a challenge that is reported by approximately one third of the USA adult population. We aimed to identify health care disparities and its correlation with prevalence of cancer as well as delays in medical care due to financial challenges among Texas residents. Methods: We analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) 2017. We measured specific health care disparities including patient’s gender, age, race/ethnicity, body mass index (BMI), annual income, alcohol consumption, history of cancer, and delays in medical care due to financial burden, among respondents to the 2017 BRFSS survey from Texas. We computed the difference between our comparison groups using chi-square test for categorical variables and t-test for continuous variables. Results: We analyzed the differences in health care disparities among respondents with and without history of cancer. We report results from 11,165 adult respondents who reside in Texas, among which nine percent were diagnosed with cancer. We noticed a higher proportion of females than males among participants with a history of cancer (64% females p < 0.0001). Age did differ between both groups, with the majority of participants with cancer are aged 50 years and older. Interestingly, BMI did not differ between both groups (p-value = 0.6930). Although annual income did not differ between both groups, twelve percent of participants with cancer diagnosis suffered from delays in medical care due to financial burden. Racial disparities were statistically different between participants with or without cancer (p < .0001). Seventy seven percent of patients with cancer diagnosis were White and non-Hispanic with a cancer prevalence rate of 12% in that racial group. On a stratified analysis to compute the relationship between delayed medical care due to financial burden and cancer diagnosis among all ethnic groups, it was not statistically different (p-value = 0.1063). We showed that prevalence of cancer among multiracial participants and other racial minorities was higher in the group of participants who reported delays in medical care due to financial burden (11% versus 7%). Conclusions: Racial and ethnic disparities could affect accessibility to medical services. Race is a significant variable that is associated with cancer, with higher prevalence of cancer in White and non-Hispanic. Delayed medical care due to financial burden is more pronounced in multiracial population and racial minorities and should be targeted in future quality improvement projects.
Health disparities experienced by Black Americans with multiple myeloma in the United States: A population-based study.
Authors: Al Hadidi Samer , Dongarwar Deepa , Salihu Hamisu , Kamble Rammurti T. , Lulla Premal D. , Hill LaQuisa , Carrum George , Ramos Carlos Almeida , Heslop Helen E. , Usmani Saad Zafar 
Published: June 2021

e18512 Background: Multiple Myeloma (MM) is the most common hematologic malignancy in Black Americans. Incidence and death rates for MM in Black Americans are more than double those in Whites. Our study aimed to evaluate trends of all cause in-hospital mortality among Black Americans with MM and to investigate characteristics of MM-related hospitalizations. Methods: We conducted a retrospective cross-sectional study of hospitalizations in adult patients with MM during 2008-2017 using the National Inpatient Sample (NIS), the largest all-payer inpatient care database in the US. We used joinpoint regression to assess temporal trends in the national incidence of in-hospital death. We conducted adjusted survey logistic regression to generate adjusted odds ratios to measure the likelihood of in-hospital death among MM related hospitalizations. Results: Admissions related to MM constituted 0.32% of all hospitalizations in the study period (913,967 out of 285,876,821). The prevalence of MM related hospitalizations was higher in Black Americans when compared with Whites (476.0 vs 305.6 per 100,000 hospitalizations, p <0.01). In-hospital mortality with MM was higher in older patients, males, those belonging to lowest zip code quartile, and who self-paid for their treatment. Average Annual Percent Change (AAPC) showed a statistically significant decline of in-hospital mortality among all MM patients except Black Americans who had the highest inpatient mortality in 2016 and 2017. Black Americans received less autologous stem cell transplantation (ASCT) (2.8% vs. 3.8%, p <0.01), more blood product transfusions (23.0% vs. 21.1%, p <0.01), less palliative care consultation (4.0% vs. 4.6%, p <0.01), less chemotherapy (10.8% vs. 11.2%, p <0.01), and more intensive care utilization (5.3% vs. 4.3%, p <0.01), when compared with Whites. Adjusted association between race/ethnicity and various outcomes confirmed observed differences [Table]. Conclusions: Black Americans with MM had the slowest improvement and highest inpatient mortality in recent years. Data suggests higher disease burden, more frequent hospitalizations, delay in accessing care and lower utilization of supportive care measures compared with White MM patients. Data highlight disparities in MM care for Black Americans necessitating a clarion call for urgent changes in health care systems.[Table: see text]
Social vulnerability and clinical trial access for older adults with myeloma in North Carolina.
Authors: Grant Shakira Jeanene , Jansen Matthew , Tuchman Sascha , Rubinstein Samuel M. , Lichtman Eben I. , Charlot Marjory 
Published: June 2021

e18540 Background: Multiple myeloma (MM) is a disease of aging, associated with one of the greatest black-white disparities in incidence and mortality among all US cancer types. Clinical trials provide the critical evidence-base to inform clinical management in all cancers, including MM. However, clinical trial participants are often younger (age < 65 years) and white, limiting the generalizability of published data to real-world MM care. Although geographical and financial barriers to clinical trial participation are well recognized, less is known about the association of county-level social vulnerability with MM trial availability. We examined county-level variation in the number of registered myeloma trials per 10,000 North Carolina (NC) residents age ≥ 65 years as a function of social vulnerability and the presence of a National Cancer Institute Comprehensive Cancer Center (CCC). Methods: We conducted a cross-sectional study using data from ClinicalTrials.gov to identify all registered interventional myeloma trials involving adults age ≥ 65 years with sites in NC. Records were downloaded on January 24th, 2021. This strategy yielded 456 non-unique NC sites for 223 trials. We obtained county locations for all trial sites by matching city, zip code, or institution name. We obtained NC population data for residents age ≥ 65 years (in 2019) from the American Community Survey. The four themes (socioeconomic status, household composition, ethnic and racial minority status/language, housing/transportation) within the Centers for Disease Control Social Vulnerability Index (CDC SVI) (composite score: 0-1, with a higher number indicating more vulnerability) were used to characterize county-level social vulnerability. We performed negative binomial regression and tabulations using R, version 3.6.1. A p-value < 0.05 was considered statistically significant. Results: Across 100 counties in NC, trial site counts by county per 10,000 residents age ≥ 65 years ranged from 0 to 23.2 (mean: 1.5, median: 0; IQR, 0-0.7). Controlling for the 4 SVI themes, counties with CCCs (Durham, Forsyth, Orange) had 77% more trials than those without CCCs [Incidence Rate Ratio (IRR): 7.74; p = 0.05]. We observed a 3.3% reduction in trial counts with each percentile increase in socioeconomic vulnerability (IRR: 0.97; p = 0.008). Counties with higher representation by racial and ethnic minorities had similar trial site counts to counties with lower minority populations (IRR: 1.01; p = 0.08). Sub-group analyses of early-stage studies (phase 1/2 and phase 2; n = 268) and late-stage studies (phase 2/3 and phase 3; n = 168) were similar. Conclusions: Our preliminary results suggest county-level socioeconomic status is associated with the distribution of MM clinical trial sites across NC. Further work is planned to explore whether additional variances in trial distribution could be explained by site- and study-specific characteristics.
Trends in breast cancer survival by race-ethnicity in Florida.
Authors: Hines Robert Brooks , Johnson Asal , Lee Eunkyung , Erickson Stephanie , Rahman Saleh M.M. 
Published: June 2021

e18556 Background: Considerable efforts to improve disparities in breast cancer outcomes for underserved women have occurred over the past 3 decades. This study was conducted to evaluate trends in survival, by race-ethnicity, for women diagnosed with breast cancer in Florida over a 26-year period to assess potential improvement in racial-ethnic disparities. Methods: This was a retrospective cohort study of women diagnosed with invasive breast cancer in Florida between 1990-2015. Data were obtained from the Florida Cancer Data System. Women in the study were categorized according to race (white/black) and Hispanic ethnicity (yes/no) as non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic white (HW), and Hispanic black (HB). Cumulative incidence estimates of 5- and 10-year breast cancer death with 95% confidence intervals (CI) were obtained by race-ethnicity, according to diagnosis year. Subdistribution hazard models were used to obtain subdistribution hazard ratios (sHR) for the relative rate of breast cancer death accounting for competing causes. Results: Compared to NHW women, minority women were more likely to be younger, be uninsured or have Medicaid as health insurance, live in high poverty neighborhoods, have more advanced disease at diagnosis, have high grade tumors, have hormone receptor negative tumors, and receive chemotherapy as treatment. Minority women were less likely to receive surgery. Over the course of the study, breast cancer mortality decreased for all racial-ethnic groups, and racial-ethnic minorities had greater absolute and relative improvement in breast cancer survival for nearly all metrics compared to non-Hispanic white (NHW) women. However, for the most recent time period (2010-2015), black women still experienced significant survival disparities with non-Hispanic black (NHB) women having twice the rate of 5-year (sHR = 2.04: 95% CI; 1.91-2.19) and 10-year (sHR = 2.02: 95% CI; 1.89-2.16) breast cancer death. Conclusions: Despite efforts to improve disparities in breast cancer outcomes for underserved women in Florida, additional targeted approaches are needed to reduce the poorer survival in black (especially NHB) women. Our next step is to conduct a mediation analysis of the most important factors driving racial/ethnic disparities in breast cancer outcomes for women in Florida.