bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving access to timely pain management in an underserved oncology clinic: A palliative care-oncology partnership.
Authors: Chan Aaron , Firtat Radu , Metchnikoff Christopher , Wu Phillis , Yu Katherine 
Published: June 2021

e18672 Background: In the 4 years since inception, the palliative care (PC) clinic at Olive-View UCLA Medical Center (OVMC) cared for less than 6% of pain-positive cancer patients based on guidelines put forth by ASCO. As with other under-resourced safety-net settings, the demand for PC services at OVMC far exceeds the manpower available for optimal pain management in oncology patients. This year long project aims to improve pain management in a busy oncology clinic via enhanced identification and prompt treatment of cancer pain by Oncologists. Methods: At the project start, Oncologists were surveyed to identify key elements to be incorporated into formal didactics on pain management principles, case-based discussions and real-time mentoring. At the weekly oncology clinic, patients were screened for pain using the multi-modal PEG scale: Average Pain intensity (P), interference with Enjoyment of life (E), and interference with General activity (G) over the preceding week. The Oncologist was notified of the PEG score if a patient had an average score ≥4 (0-10 scale) for review and intervention. Patients were screened using the same method at subsequent visits. EHR of patients with PEG scores ≥4 were reviewed to determine whether therapeutic interventions were made by the Oncologist. A comparison of PEG scores to the standard nursing intake pain scores was also conducted. Results: Over a 4-month period, 513 PEG forms were administered, 37% of which resulted in a pain score ≥4. Of the 172 patients who screened positive, 54 patients were screened at follow up visit(s). Comparing the pain-positive cohort, we observed an average decrease in pain by 25.5% (7.1 to 5.3) in patients who received intervention as opposed to 7.4% (5.0 to 4.7) in patients who did not receive intervention by their Oncologist. Further, there was a remarkable divergence between the average PEG score (6.7) and nurse intake pain score (1.4) in this patient cohort. Conclusions: Our findings suggest that improved Oncologist real-time pain assessment and intervention incorporating a validated pain screening tool leads to timely pain management in cancer patients. Implementation of a Palliative Care-Oncology partnership promotes provider awareness and confidence in treating patients with complex pain. A functional pain assessment, using PEG, can more accurately reflect pain compared to the current standard nursing intake process. Particularly in resource challenged settings where access to PC is limited, facilitating timely pain management through training and mentoring of oncologists or other primary providers can be a sustainable model to improve patient access to primary palliative care. Given the early indicators of success we hope to expand this workflow in training other healthcare providers within our County safety net system. Research Sponsor: California Health Care Foundation.
Early impact of lung cancer screening program.
Authors: Emmerick Isabel M. , Lou Feiran , Powers Maggie M. , Guiab Keren , Bludevich Bryce , Lin Poliana , Maxfield Mark , Uy Karl 
Published: June 2021

e18677 Background: Lung cancer has the highest mortality among the leading cancers in the U.S. Its detection in the early stages is one of the strategies to increase survival. This study aims to identify whether the implementation of a structured Lung Cancer Screening Program impacted the percentage of Early Stage Lung Cancer Diagnosis (ESLCD). Methods: Retrospective cohort study aiming to identify changes over time considering the following indicators: a) percentage of ESLCD; b) the percentage of lung resections for ESLCD. In October 2019, there was a restructuring of our institutional Lung Cancer Screening Program (LCSP). We analyzed quarterly incident lung cancer cases at our institution between October 2017 and December 2019. Descriptive, bivariate, and multivariate analyses were performed. Results: Our cohort comprised 736 patients. The age average was 69.3 years, 54.6% female, 96.5% white. Clinical Stage 1A to 2B corresponded to 43.3% of patients. 71.9% had their diagnosis and treatment in the institution. Factors associated with ESLCD were being in the LCSP (OR 4.4 [95%CI 2.3-8.1]); diagnosis and treatment in the institution (OR 2.2 [95%CI 1.6-3.2]); having 3 or less comorbidities (OR 1.6 [95%CI 1.2-2.1]) and female (OR 1.4 [95%CI 1.1-1.9]). In the last Quarter of 2017, the percentage of ESLCD through LCSP was 2.6%, and in the last Quarter of 2019 (2019Q4), 28.8%, representing a 1025% growth. Also, in 2019Q4, 44.8 % of the ESLCD cases that had surgery came through the LCSP, which is a significant increase from prior quarters. Conclusions: The restructuring of our LCSP may have resulted in an increase in ESLCD and the number of curative surgeries for Lung Cancer. Identification of opportunities for improvement of health care delivery can help to increase ESLCD; a longer time for follow-up is needed to observe if the upward trend is sustained and its effects on patient survival. Selected indicators by quarter, 2017 to 2019.[Table: see text]
Real-world treatment patterns among advanced HR+/HER2- breast cancer patients in the post-CDK4/6 inhibitor era: An analysis of administrative claims data.
Authors: Boyle Tirza Areli Calderón , Shukla Soham , Powers Happ Lindsey , Zheng Shan , Gorsh Boris 
Published: June 2021

e18695 Background: The treatment paradigm for advanced HR+/HER2- breast cancer has been rapidly evolving since the approval of the first CDK4/6 inhibitor in the U.S. in 2015. Available literature on real-world utilization of various treatment options available to these patients remains limited. The objective of this study was to describe how advanced HR+/HER2- breast cancer treatment patterns have changed over time since the approval of novel CDK4/6 inhibitors. Methods: IBM MarketScan Research Databases, a nationally representative source of U.S. insurance claims data, was used to identify women diagnosed with advanced breast cancer between January 2015 and December 2019 via ICD-9/10 codes. Algorithms were applied to capture patients with HR+/HER2- subtype and advanced disease diagnosis. Patients were indexed on their advanced breast cancer diagnosis date and were required to have six months continuous enrollment in the insurance claims database prior to and after the index date to ensure patients included in the cohort were alive and contributed at least 12 months of data for analysis. Lines of therapy (LOTs) were constructed and treatment patterns were reported over time. Descriptive analyses were conducted using Instant Health Data software. Results: A total of 4,128 women (mean age: 58 years, IQR: 50-64 years) had received at least one systemic breast cancer treatment and were included in the analysis. During a mean follow-up time of two years, nearly 29% of patients received at least four LOTs for advanced disease. A high number of unique regimens were reported in each LOT (30 in 1L, 48 in 2L, 53 in 3L and 50 in 4L+). The distribution of the top 1L regimens changed significantly over time (Table). CDK4/6 inhibitor use in the 2L setting also increased substantially from 43% in 2015 to 68% in early 2019, while chemotherapy and endocrine monotherapy utilization decreased. Conclusions: These data reflect a significant shift in the treatment landscape for HR+/HER2- advanced breast cancer patients in real-world practice since the availability of CDK4/6 inhibitors. However, there remains significant heterogeneity in the use of other treatments in these patients and in treatment sequencing, suggesting potential unmet need with current therapies. Further insight into patient, clinical and community-level factors guiding treatment decisions in the real world is needed. [Table: see text]
Drivers and barriers to information seeking: Qualitative research with advanced cervical cancer patients in the United States.
Authors: Szamreta Elizabeth A. , Wayser Graceanne R. , Prabhu Vimalanand S. , Mulvihill Emily , Stockstill Katherine , Salani Ritu 
Published: June 2021

e18705 Background: Patients diagnosed with persistent, recurrent, or metastatic cervical cancer (CC) may face uncertainty about treatment options, impact of treatment on health & quality of life (QoL), & available resources. This study provides insight into patient concerns & information seeking (IS) behaviors. Methods: In January 2021, semi-structured telephone interviews were conducted in the US with CC patients (diagnosed within 2 years) recruited through panels, social media & advocacy groups. The interview focused on rational & emotional drivers and barriers for IS. Transcripts were coded using NVivo qualitative analysis software to identify key themes. Results: 14 women of varied education status were interviewed (mean age 51 years (range: 37-70); 8 White, 4 Black, & 2 Latina). Patients emphasized trust in their oncologist to provide sufficient information. IS was driven by the desires to confirm their oncologist’s recommendation & find reassurance through the experience of other patients, and encouragement from family. Barriers to IS included: 1) hesitancy to undermine their oncologist’s recommendations, 2) pessimism about ability to find individualized answers about prognosis or QoL, 3) feeling overwhelmed & fearing mis-information, 4) personal urgency to decide on a treatment plan, 5) already having sufficient information, 6) potential exposure to “negative energy” from online patient communities, & 7) COVID-19 hindering opportunity for personal connections. Conclusions: While patients’ oncologist, family, & common patient experience provide comfort, reluctance towards IS exists. As trusted gatekeepers, oncologists should recognize patients’ desire for accessible, reliable, & personalized information. Better understanding this perspective and gaps in the availability of validated & relevant resources can enable clinicians/policy makers to develop strategies & tools for better communication. In turn, this will help CC patients feel more empowered & informed throughout their cancer care journey.[Table: see text]
Real-world progression-free survival among patients with newly diagnosed advanced ovarian cancer: Does maintenance therapy work?
Authors: Liu Jinan , Chan John , Sah Janvi , Maiese Eric M. , Bee Oscar , Hurteau Jean , Thaker Premal H. 
Published: June 2021

e18707 Background: Options for first-line (1L) maintenance therapy in ovarian cancer (OC) have evolved in the US in recent years, particularly with FDA approvals of poly(adenosine diphosphate [ADP]-ribose) polymerase inhibitors (PARPi). Olaparib was approved in 2018 for 1L maintenance treatment of patients (pts) with advanced OC with BRCA mutation and in 2020 as combination therapy with bevacizumab for 1L maintenance treatment of pts with homologous recombination deficient (HRd)–positive tumors. Additionally, the FDA approved niraparib in 2020 for maintenance treatment of pts with advanced OC regardless of tumor biomarker status. This study aimed to describe use and outcomes of 1L maintenance vs. active surveillance (AS) among PARPi-eligible pts with OC in a real-world setting prior to the most recent 2020 FDA approvals. Methods: This retrospective cohort study included pts with newly diagnosed stage III/IV OC who received 6–9 cycles of 1L platinum-based chemotherapy (PBC) and either primary debulking surgery or interval debulking surgery following neoadjuvant chemotherapy between January 1, 2016, and February 29, 2020, regardless of biomarker status, from the Flatiron Health database, a longitudinal electronic health record-derived database consisting of de-identified patient-level data that are curated via technology-enabled abstraction. The end of the last cycle of 1L PBC was defined as the index date. Pts who started second-line (2L) treatment within 2 months of the index date were excluded. Primary endpoint was time to initiation of 2L systemic therapy (as a surrogate for progression) or death. Inverse probability of treatment weighting and Cox proportional hazard model were used to adjust for baseline differences among pts on maintenance therapy and pts on AS. Results: A total of 463 pts were included in the study, 87.7% from community practices and 12.3% from academic institutions. Of the pts included, 21.0% received maintenance therapy, while 79.0% did not. Of those who received maintenance therapy, 48.5% received bevacizumab, 40.2% received PARPi (olaparib, rucaparib), and 11.3% received paclitaxel. Median progression-free survival (PFS) for pts who received 1L maintenance therapy was 16.1 months, compared with 12.2 months in pts who did not receive 1L maintenance therapy. After adjusting for baseline differences in characteristics and demographics, including age, race, stage of cancer, and BRCA status, pts on maintenance therapy had a statistically significant, 29% lower risk of progression or death than those receiving AS (hazard ratio: 0.71; 95% CI, 0.52–0.99; P= 0.04). Conclusions: In this real-world analysis, the majority of pts did not receive maintenance therapy; however, a PFS benefit was found in those receiving maintenance therapy. Further studies are needed to understand how biomarker status drives practice patterns.
Head-to-head comparison of first-line FOLFIRINOX versus gemcitabine plus nabpaclitaxel (GN) in advanced pancreatic cancer (APC): A target trial emulation using Canadian real-world data.
Authors: Boyne Devon J. , Brenner Darren , Gupta Alind , Mackay Eric , Arora Paul , Wasiak Radek , Cheung Winson Y. , Hernan Miguel 
Published: June 2021

e18713 Background: When randomized trials are not available, observational real-world data can be used to emulate a (hypothetical) target trial. The procedure starts with the specification of the protocol of the target trial, whose components are then explicitly emulated using observational data. This approach prevents biases that are common when using more conventional methods for real-world data. Advanced pancreatic cancer represents an opportunity for trial emulation since two main frontline therapies, FOLFIRINOX and GN, have never been directly compared in a randomized fashion. The choice between the two regimens is largely based on physician discretion and patient preference rather than direct comparison of effectiveness. Methods: We emulated a target trial using linked data from the provincial cancer registry, electronic health records and various administrative databases from Alberta, Canada. Eligible individuals had locally advanced or metastatic pancreatic cancer diagnosed between Jan. 2015- Dec. 2018, no prior treatment, and adequate hematologic and serum creatinine values. They were followed from diagnosis until March 2020, death, or date of last known contact with the healthcare system. We estimated the effect of initiating FOLFIRINOX vs. GN within 8 weeks of diagnosis on overall survival. Cloning, artificial censoring, and inverse probability weighting were used to address unknown treatment assignment at baseline, non-adherence, and confounding. Adjusted Kaplan-Meier survival curves and hazard ratios were estimated. Results: Of 298 eligible individuals, 70 adhered to the FOLFIRINOX strategy and 147 to the GN strategy. The mean age was 65 years, 173 (58%) were male, and 247 (83%) had metastatic disease. The adjusted median survival, 1-year survival, and 2-year survival for FOLFIRNOX was 8.2 months (95% CI: 5.3 to 9.4), 36.9% (22.2 to 55.8), and 14.1% (4.8 to 32.2), respectively; and for GN was 4.8 months (3.3 to 5.3), 22.2% (13.6 to 35.9), and 4.7% (1.7 to 13.0), respectively. The adjusted difference in median survival was 3.4 months (0.6 to 11.1) and the adjusted hazard ratio was 0.79 (0.56 to 1.05). Conclusions: Target trial emulations can help to inform medical decision making in situations where head-to-head randomized trial data are unavailable or unfeasible. Findings from this real-world trial emulation suggest improved overall survival with FOLFIRINOX over GN.
Characterizing safety and efficacy in ovarian cancer patients with thromboembolism treated with rivaroxaban.
Authors: Kohn Christine G. , Caranfa Jonathan T. , Brewer Molly , Singh Meghana , Coleman Craig I. , Costa Olivia S. 
Published: June 2021

e18720 Background: There is a paucity of real-world data regarding rates of recurrent venous thromboembolism (VTE), major bleeding and all-cause mortality among ovarian cancer patients with thrombosis treated with direct oral anticoagulants (DOACs) currently available. We sought to evaluate the effectiveness and safety of rivaroxaban versus low molecular-weight heparin (LMWH) for cancer-associated thrombosis (CAT) treatment in patients with ovarian cancer. Methods: We utilized US Surveillance, Epidemiology and End Results-Medicare–linked data from 2013-2016 to identify adults with active ovarian cancer, undergoing hospitalization/emergency department admission for CAT and prescribed rivaroxaban or LMWH for outpatient anticoagulation. Rivaroxaban and LMWH cohorts were balanced using propensity score overlap weighting . Outcomes included the composite of recurrent thrombosis or major bleeding, each outcome separately and mortality at six-months using an intention-to-treat approach. On-treatment analysis after 12-months was also performed. Hazard ratios (HRs) with 95% confidence intervals using overlap weighted cox regression were reported. Results: We included 33 rivaroxaban and 92 LMWH-managed CAT patients. In each cohort, mean age was 73, 79.5% of patients were white, 46.9% had a history of ≥ stage 3 chronic kidney disease (CKD), two-thirds had metastatic disease at the time of VTE, and 32.6% had a prior VTE. Patients were diagnosed with ovarian cancer an average of 1.40 years prior to the index VTE event and 45.8% had a pulmonary embolism (with or without DVT) as the index event. Our analysis did not detect a significant difference in outcomes with rivaroxaban versus LMWH at six-months (Table). On-treatment analysis at 12-months showed similar results. Conclusions: Rivaroxaban may be a reasonable alternative to LMWH for CAT patients with ovarian cancer. Large observational studies are needed to confirm these results.[Table: see text]
Analyzing inmuno-related adverse event: A real-world DATA study.
Authors: Cantos Blanca , Sanchez Juan Cristobal , Nuñez García Beatriz , Mendez Miriam , Gonzalez del Alba Aranzazu , Sanchez Antonio , Cubedo Ricardo , Hernandez Lopez Roberto , Calvo Virginia , Provencio Mariano 
Published: June 2021

e18751 Background: In the last years, Immunotherapy (IT) has emerged as a standard treatment in an increasing number of tumors. This type of treatment has a specific toxicity profile which is clearly different from chemotherapy, known as an Immuno-related Adverse Event (AEir). We know the data from clinical trials, but little about the incidence and impact of this EAir in our clinical practice. Methods: A retrospective observational study was carried out including all patients from our institution (HUPHM in Madrid) who had received IT, either in monotherapy or in combination between January 2014 and December 2019. A total of 279 patients were included and data were collected between January and July 2020, guaranteeing a minimum 6-month follow-up after receiving the first dose of immunotherapy. The toxicities found were classified into four categories: pulmonary, digestive, endocrine and others, and have been graded according to CTCEA v.5 (Common Terminology Criteria for Adverse Event) published in November 2017 and analyzed according to drug and tumor. Results: The most frequent diagnoses in our patients were: 60% lung carcinoma, 15% melanoma, 8% kidney carcinoma, and 6% bladder carcinoma. 76% of the patients received IT as first or second line in a metastatic context, 6% in the initial stage (clinical trials) and the rest in more advanced lines of treatment (3 or more). 67% received anti-PD1 drug, 6% anti-PDL1, 4% anti-CTL4 monotherapy, 10% a combination of several IT drugs, and 14% an IT combination and chemotherapy. 45% of the total presented EAir (16% grade I, 14% grade II, 11% grade III and 4% grade IV). 1/5 of the patients had manifestations in more than one organ. The incidence of the different toxicities in our population was listed in the table below. These patients reported 8% dermatological toxicities, 6% had renal toxicity (most of them grade III or IV), only 2% had arthralgia or myalgia, and 3% asthenia. Combined IT treatment had significantly higher rates of pneumonitis, colitis, and endocrine toxicities. These differences were not observed between the monotherapy treatment and the combination of immunotherapy plus chemotherapy. Conclusions: Immunotherapy has represented an important advance in oncology, achieving long survivals in a growing group of tumors. Immunotherapy has a unique toxicity profile that is very different from chemotherapy and with which we must become familiar. Most of the adverse events are mild and if they are diagnosed early and with the appropriate treatment, maintenance of IT is possible. Severe toxicity (III-IV) means in most cases the suspension of treatment, compromising its efficacy. Therefore, we must learn to recognize these toxicities early and apply the recommended treatments as soon as possible.[Table: see text]
Lung cancer health services utilization and associated cost for the Colombian health system: A propensity score analysis of a national cohort of prevalent patients.
Authors: Buitrago Giancarlo , Amaya-Nieto Javier , Torres Gabriel Fernando 
Published: June 2021

e18784 Background: There is need for high quality data about the economic burden of disease in low- and middle-income countries. We aimed to determine the annual incremental cost of health care services utilized by lung cancer patients in the Colombian health system. Methods: We conducted a national cohort study of prevalent patients with lung cancer in Jan-2017 and followed-up until Dec-2017. We used two electronic algorithms to identify all lung cancer prevalent patients in the Contributory regime, using national health claims databases ( Base de datos de suficiencia de la Unidad de Pago por Capitación and Base de Datos Única de Afiliados), based on identification of ICD-10 codes for 4 months or more during the previous 3 years (sensitive algorithm) and adding the presence of at least one oncological procedure (specific algorithm). We identified all health services cost from the health system perspective (2017 USD). We performed a propensity score analysis to estimate the annual incremental cost of care of patients with lung cancer compared to those without the disease. Standardized differences lower than 0.1 were used to measure the balance of baseline variables. We used generalized linear models as a sensitivity analysis. Results: We identified 4,827 and 3,238 lung cancer prevalent patient using the sensitive and specific algorithm, respectively. Each cohort was matched 1:1 with a no-exposed cohort of 14,968,202 individuals without a diagnosis of lung cancer using a caliper of 0.0001. Matched samples showed good balance on baseline characteristics. Annual incremental cost for patients diagnosed with lung cancer in Colombia ranged between USD $ 3,146.92 and USD $ 4,156.23. We also estimated incremental cost for outpatient and inpatient healthcare services as shown in table. Conclusions: In 2017, each patient with lung cancer represented an incremental cost to the Colombian health system between 49.35% and 65.19% of GDP per capita. This information is paramount to understand lung cancer spending in Colombia and for other low- and middle-income countries. [Table: see text]