bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient reported outcomes and predictors of distress.
Authors: Meadors Patrick Leland , Trufan Sally J , Walsh Kendall , Walsh Declan 
Published: May 2019

6559 Background: ASCO/NCCN guidelines recommend screening for multifactorial distress in cancer patients. Understanding predictors of cancer related distress can lead to early intervention and improve clinical outcomes, symptom management, and operational efficiency. Through electronic distress screening (EDS), patient reported outcomes (PRO) were collected across 42 practice locations. Methods: EDS has 39 questions related to cancer related distress including: distress, cancer symptoms/side effects, malnutrition, depression, anxiety, social/family support, financial, and spiritual concerns. 27,106 patients completed screens between 2017-2018. Multivariate analysis and logistic regressions determined predictors of distress for completed screens overall, registry matched, and within 60 days of diagnosis. Results: Median age was 59 (IQR 18-101) and 65% were female. Five symptoms consistently predicted clinically significant distress ≥ 4: anxiety, fatigue, pain, poor emotional coping, and sleep. Diagnosis (dx), staging at time of dx, and timing of screen did not independently predict distress. Factors predicting clinically significant distress varied across geographic regions. Conclusions: In large patient population, five key PROs are predictive of clinically significant distress and could potentially impact clinical outcomes. Early PROs predictive of distress were consistent along the continuum, thus the importance of early symptom identification. EDS can help custom tailor supportive oncology programs to mitigate symptoms related to cancer distress. [Table: see text]
Unique perspectives from the transgender community: A retrospective chart review of cancer care needs for transgender patients.
Authors: Moloney Carolyn , Allen Margaret , O'Mahony Deirdre , Power Derek , Bambury Richard , O'Reilly Seamus , Collins Dearbhaile Catherine 
Published: May 2019

6566 Background: It is estimated that 1% of a population experience some degree of gender non-conformity. There is scant information worldwide on cancer incidence and mortality for this population however due to a lack of investigating large-scale prospective studies. National cancer registries do not hold demographics on this population. Current literature indicates transgender people may face an increased cancer risk. Transgender patients may avoid screening programmes for cancers which are themselves gendered. Transgender patients can feel excluded from gender specific cancer support groups. We set out to identify how cancer services in Ireland can better meet transgender people’s unique needs. Methods: Medical oncology consultants in the South/South-West of Ireland were contacted to identify patients who identified as transgender or gender non-conforming. We carried out a retrospective chart review of the four transgender patients identified. We analysed staging at diagnosis, family supports, smoking history, alcohol use and whether cancer treatment affected gender transitioning treatment and if this had documented effects on mental well-being. We also noted if medical records reflected a new name or change of gender and if not, whether original name and gender used for chemotherapy and blood product administration. Results: All four patients were diagnosed with relatively advanced disease at diagnosis- Stage IIIc high grade ovarian cancer, stage IV gastrointestinal tumour, stage IVb diffuse large B Cell and locally advanced extra-abdominal desmoid tumour. Of the four patients, three had a smoking and alcohol history on diagnosis. All four patient’s recent medical correspondence reflected a name and gender change but the medical records did not reflect this. Three patients had documented depression for which they were attending psychiatry services. It was noted that two patients had gender transitioning treatment postponed due to cancer care. Minimal family support was noted for two patients. Conclusions: The transgender community is a growing population that will continue to integrate into mainstream society. Our retrospective chart review adds to a growing body of evidence which suggests gender minorities may suffer from cancer-related disparities and have an increased need for psychosocial support. As in other studies, it is difficult to identify these individuals. We should identify gender minority individuals and report this data in medical records in order to build much needed epidemiological information.
Impact of race/ethnicity in the clinical presentation and outcomes of patients with multiple myeloma in an underserved urban population.
Authors: Torres Christian , Andrade Gonzalez Xavier Alberto , Katiyar Vatsala , Del Cid Juan , Mendez Hernandez Andres , Munoz Ezequiel , Sumoza Luis David 
Published: May 2019

6570 Background: Patients with multiple myeloma (MM) who are part of racial/ethnic minority groups have been typically underrepresented in large descriptive and randomized-controlled studies. Despite the identification of biological and genetic risk factors, the impact of race/ethnicity in the outcomes of patients with MM remains largely unknown. We aimed to describe the racial/ethnic differences in clinical presentation and outcomes of patients with MM in an ethnically-diverse underserved urban population. Methods: We conducted a single-center retrospective study of patients with MM from Jan 1st 2008 – Dec 31st 2016 using ICD coding from our tumor registry. We abstracted demographic, clinical and treatment variables. We used Chi-square to compare categorical variables and Kaplan-Meier method for survival analysis. Statistical analysis was performed using IBM SPSS version 25. Results: We identified 73 patients with MM with a median follow up time of 42 months (Range 1 to 81 months). Patients had a median age of 59 years (Interquartile Range [IQR] =17) and were predominantly male (54.8%). The most frequent racial/ethnic group was African American (AA) (59%) followed by Hispanic (27%) and Caucasian (8%). When compared to other ethnicities, patients who were AA had higher ISS-3 scores (41% vs 23% p=0.101) worse cytogenetic risk (65% vs 30% p=0.009) and worse response after induction (Complete response [CR] 47% vs 77% p=0.047). They were also more likely to have medical insurance coverage than other ethnicities (67% vs 27% p=0.003) but had similar access to autologous bone marrow transplant (23% vs 23% p= 0.99). Overall, AA patients had worse overall survival (OS) compared to all other ethnic groups (mean OS: 58.3 months vs 79 months p=0.014). Conclusions: AA patients with MM had more aggressive disease and worse OS compared to other ethnicities which may suggest an underlying genetic predisposition towards high-risk genetic features. Improvement of access to autologous bone marrow transplantation may improve survival in high-risk racial/ethnic groups.
Cervical cancer screening in incarcerated women: An experience from the first cervical cancer screening campaign in a southern Thailand correctional facility.
Authors: Jiamset Ingporn , Sakdejayont Siwat , Rattanakhot Nanthiya , Peeyananjarassri Krantarat , Dechaphunkul Arunee , Sunpaweravong Patrapim 
Published: May 2019

6572 Background: Cervical cancer is one of the most preventable cancers, not only presence of effective HPV vaccination but also simple and robust screening methods such as Pap test. Nevertheless, there were some women at risk whom were unable to access screening cause of incarceration. Hence, in 2018, together with Songkhla Woman Correctional Institute, we launched a cancer screening campaign including clinical breast exam, mobile mammography and Pap test. This is the first report of cervical cancer screening result demonstrated the essential of cervical cancer screening in these disadvantaged women. Methods: Due to the regulation of the jail, we had to limited bring-in tools, allowed staffs and operating-time, therefore we used a pre-screening questionnaire, included 5 items: HIV infection, number of partner, parity, age at first sexual intercourse and number of term baby and each of them scored as 2 for “high-risk” and 1 for “low-risk”, total score ranged from 5 to 10. We ranked and chose the volunteer participants, who have HIV infection and/or with highest risk score, to undergo Pap test. Results: Of the 1328 questionnaire responders, Their mean risk score was 7.3 (SD= 1.3). HIV infected participants number were 34 (2.5%). Of the 200 screened-participants, None of them had ever received HPV vaccination before, and all participant did not have Pap test since imprisonment. (mean 53.8 m, range 13-236 m, SD 36.7). Their score ranged between 8 to 10, 42.5% of them had score level 8, 54.5% had score level 9 and 3% had score level 10. Mean age was 37.7 years. 10 (5%) of them had abnormal Pap test; 1 of them showed ASC-US, 1 was LSIL, 1 was ASC-H, 5 of them showed HSIL and 2 of them showed squamous cell carcinoma and small round cell carcinoma. Final histopathological test resulted in 6 of cervical intraepithelial neoplasia (CIN) I, metaplasia and cervicitis, 3 were diagnose CIN III and 1 diagnosed microinvasive carcinoma. Incidence of cervical cancer was higher than normal population in this region. (0.5% vs 0.02%). Conclusions: Incarcerated women were at high risk of cervical cancer compared to normal population. Unfortunately, in many places, they were unconditionally inaccessible to the cervical cancer preventive healthcare system for years. Social should increase awareness to decrease this health disparity.
Diagnostic and treatment delays in young women with breast cancer.
Authors: Poorvu Philip D , Zheng Yue , Sella Tal , Rosenberg Shoshana M. , Ruddy Kathryn Jean , Gelber Shari I. , Tamimi Rulla M , Peppercorn Jeffrey M. , Schapira Lidia , Borges Virginia F. , Come Steven E. , Warner Ellen , Partridge Ann H. 
Published: May 2019

6575 Background: Delays in diagnosis (dx) and treatment (tx) affect breast cancer (BC) outcomes. We sought to identify factors associated with delays among young women, who do not undergo routine screening and often have pregnancy or breastfeeding-related breast changes that may mask a BC. Methods: The Young Women’s Breast Cancer Study is a multicenter, prospective cohort that enrolled 1302 women with newly dx BC age ≤40 between 2006-2016. Women reported the method and timing of cancer detection on the baseline survey. 231 were ineligible or excluded due to missing information. Among those reporting self-detected cancers, using multivariable regression we evaluated factors associated with delays ≥90 days (d) from symptom to presentation (self delay) and presentation to dx (care delay); in stage 0-III BC we evaluated delays ≥60d from dx to tx (tx delay). Results: 1071 eligible women had median age at dx of 37 yrs (17-40) and 74% reported self-detected cancers. Self delay or care delay ≥90d was reported in 17% and 13%, respectively. Factors inversely associated with self delay included pregnancy at dx (vs nulliparous, OR 0.10, CI 0.01-0.78) and perceived financial comfort (vs not, OR 0.62, CI 0.41-0.93). Women dx ≤1 year post-partum who breastfed (vs nulliparous, OR 2.60, CI 1.14-5.93) and those with a family history of breast/ovarian cancer (vs none, OR 1.79, CI 1.00-3.19) were more likely to have a care delay. Age was inversely associated with care delays (OR 0.94, CI 0.89-0.99). Tx delay was reported by 10% (105/1015), and associated with being single (vs partnered, OR 1.61, CI 1.02-2.56 ), non-white (vs white, OR 1.85, CI 1.09-3.13) and having Stage 0 BC (vs stage 1, OR: 3.08, CI 1.65-5.77); women with stage 3 BC (vs stage 1, OR 0.13, CI 0.03-0.56) were less likely to have a tx delay. Conclusions: In this cohort, most young women with BC underwent timely dx and tx initiation. Women dx ≤1 year post-partum who breastfed were more likely to experience a care delay, likely because lactational changes may mask BC signs and symptoms. The associations of perceived financial status with self delay and non-white race with tx delay underscore the need for additional support to ensure timely care for underserved populations with the goal of eliminating disparities in outcomes.
Association of diagnosing physician and hospital characteristics with the use of radical cystectomy among patients with muscle-invasive bladder cancer.
Authors: Mehta Hemalkumar B , Golla Vishnukamal , Ray-Zack Mohamed Danny , Shan Yong , Kuo Yong-Fang , Chamie Karim , Williams Stephen Bentley 
Published: May 2019

6576 Background: Only one out of five muscle-invasive bladder cancer patients receive radical cystectomy, a guideline-recommended treatment. Prior studies evaluated patient characteristics associated with radical cystectomy use. We aimed to determine bladder cancer diagnosing physician and hospital characteristics associated with the use of radical cystectomy. Methods: This cohort study used linked SEER-Medicare Data from 2002 to 2011. We included older adults (age>65 years) diagnosed with muscle-invasive bladder cancer. For each patient, a urologist who performed transurethral resection of bladder tumor was assigned as a diagnosing physician. The diagnosing physician was assigned to one hospital based on where he/she performed more than half of all urologic surgeries. Two-level hierarchical model (patients nested within hospitals) were constructed to determine the association of patient, physician and hospital characteristics with radical cystectomy use. Results: A total of 7,097 patients were diagnosed by 4601 physicians who were affiliated with 822 hospitals. Overall, the radical cystectomy utilization rate was 26.5%. Only 4.8% of the variation in radical cystectomy was attributed to the hospital level. In the two-level hierarchical model, patients diagnosed by female physicians were more likely to undergo radical cystectomy (32.8% vs. 25.8%; OR=1.63, 95% CI=1.31-2.02). Higher radical cystectomy volume by diagnosing physicians and hospitals increased the radical cystectomy use (Table). Diagnosing physician characteristics (age, years in practice, employment status), and hospital characteristics (teaching states, location, type of hospital) were not associated with radical cystectomy use. Patient characteristics such as age, male, higher comorbidity burden were associated with lower likelihood of radical cystectomy use. Conclusions: Physician and hospital factors do not largely contribute to the receipt of radical cystectomy. Radical cystectomy volume by diagnosing physicians and hospital drives radical cystectomy use.[Table: see text]
Disparities in lung cancer outcomes for veterans with comorbid mental disorders.
Authors: Berchuck Jacob E , Meyer Craig , Zhang Ning , Trivedi Neil , Cohen Beth , Wang Sunny 
Published: May 2019

6577 Background: Emerging evidence suggests that cancer patients with comorbid mental disorders have worse outcomes. Lung cancer is the leading cause of cancer-related death in the United States, yet the impact of specific mental disorders on outcomes for patients diagnosed with lung cancer is not well known. Methods: Stage at diagnosis and receipt of stage-appropriate treatment were assessed for 55,315 Veterans with non-small cell lung cancer (NSCLC) in the Veterans Affairs (VA) Central Cancer Registry from 2000 to 2011. Patients were stratified by the presence of specific comorbid mental disorders. Multivariate analysis evaluated the association between mental disorders and survival, as well as the impact of VA treatment programs on survival. Results: Patients with schizophrenia had lower rates of localized disease at diagnosis compared to those without mental disorders. Schizophrenia and dementia were associated with significantly lower rates of stage-appropriate treatment for localized, locoregional, and metastatic disease. Conversely, patients with depression or PTSD were more frequently diagnosed with early-stage disease and significantly more likely to receive stage-appropriate treatment across all stages. After adjusting for baseline differences, stage, and rates of stage-appropriate treatment, hazard of death was higher for patients with schizophrenia (hazard ratio [HR] 1.10; 95% CI, 1.03-1.16; P < .005) and dementia (HR 1.11; 95% CI, 1.06-1.18; P < .0005). Participation in VA-based programs to address mental illness, substance use, and homelessness was associated with a significant reduction in all-cause mortality (HR 0.71; 95% CI, 0.68-0.75; P < .0001) and lung-cancer specific mortality (HR 0.73; 95% CI, 0.69-0.77; P < .0001). Conclusions: Schizophrenia and dementia are strong negative predictors of survival among Veterans diagnosed with NSCLC. VA-based mental health treatment programs are associated with reductions in all-cause and lung cancer-related mortality, highlighting the importance of funding and promoting mental health and supportive programs.
Impact of smoke-free ordinance strength on smoking prevalence and lung cancer incidence.
Authors: Nguyen Ryan , Vater Laura , Timsina Lava R , Durm Greg Andrew , Rupp Katelin , Wright Keylee , Spitznagle Miranda , Paul Brandy , Jalal Shadia Ibrahim , Carter-Harris Lisa , Hudmon Karen S , Hanna Nasser H. , Loehrer Patrick J. , Ceppa DuyKhanh 
Published: May 2019

6578 Background: Smoke-free ordinances (SFO) have been shown to decrease the prevalence of cardiovascular and pulmonary disease, but there is limited data on the impact of such policies on lung cancer incidence. We investigated the relationship between strength of county-level SFO with smoking prevalence and lung cancer incidence in Indiana. Methods: Following IRB approval, we queried the Indiana State Cancer Registry and Indiana Tobacco Prevention and Cessation Commission’s policy database between 1995 and 2016. County-level characteristics included population, income, poverty, education, race/ethnicity, sex, and rurality. Lung cancer diagnosis and stage were also collected. Using generalized estimating equations (GEE) with robust standard errors and accounting for the clustering effect at county level, we performed multivariable analyses of smoking prevalence and age-adjusted lung cancer rates with respect to the strength of smoke-free ordinances at the county level over time. Results: Indiana consists of 92 counties, 24 of which had SFO by 2011. In 2012, Indiana enacted a law mandating at least a moderate state-wide SFO. From 1995 to 2016, 110,935 Indiana residents were diagnosed with lung cancer. Indiana also had an average age-adjusted yearly lung cancer incidence of 76.8 per 100,000 population and average yearly smoking prevalence of 25% during this time. Smoking prevalence was 1.2% (95% CI [-1.88, -0.52]) lower in counties with comprehensive or moderate SFO compared with those with weak or no SFO. Counties that had comprehensive or moderate SFO had an 8.36 (95% CI [-11.45, -5.27]) decrease in new lung cancer diagnosis per 100,000 population per year compared with counties that had weak or no SFO. Conclusions: Stronger municipal smoke-free air ordinances are associated with decreased smoking prevalence and fewer new lung cancer cases. Strengthening smoke-free ordinances is paramount to decreasing lung cancer incidence.
Low nationwide utilization of adjuvant chemotherapy (AC) in elderly patients with localized non-small cell lung cancer (NSCLC).
Authors: Parikh Kaushal , Durani Urshila , Inselman Jonathan , Funni Shealeigh , Goyal Gaurav , Go Ronald S. , Leventakos Konstantinos , Mansfield Aaron Scott 
Published: May 2019

6581 Background: While AC is recommended for all patients with stage IIA, IIB, and IIIA NSCLC, its use and benefit among the elderly population is unclear. Methods: We identified patients with stage IIA, IIB, or IIIA NSCLC using the National Cancer Database from 2006-2014. Patients were divided into age groups ≤65, 66-70, 71-75, 76-80, > 80 years. Trends in AC use, factors influencing AC administration, and outcomes associated with AC were studied. Results: Out of 27368 patients, 13464 received AC and 13904 did not. 11% had stage IIA disease, 50% had stage IIB disease and 39% had stage IIIA disease. AC use was lower with increasing age (49% age ≤65 vs. 3% age > 80 (P < 0.0001)). Temporal use of chemotherapy for each age group was unchanged from 2006-2014. In multivariate logistic regression analysis, factors predictive of lower AC use were older age, Medicare or Medicaid insurance, academic center, and higher Charlson Comorbidity Index (CCI). Stage IIIA (OR 1.4, 95% CI 1.3-1.6) and Stage IIB (OR 1.3, 95% CI 1.2-1.4) had a higher chance of receiving AC than stage IIA. In a Cox proportional hazard model, younger age, female sex, academic center, private insurance, higher income, lower CCI, West coast center and AC were associated with better outcomes. When stratified by age and stage, AC was still associated with better survival (Table). Conclusions: AC utilization in stages IIA, IIB and IIIA NSCLC remains low, despite its association with improved survival in the elderly. Future clinical trials may be needed focused on elderly patients to establish the best regimen to optimize outcomes. [Table: see text]
Self-reported health and survival in older patients diagnosed with multiple myeloma.
Authors: Nabulsi Nadia Azmi , Alobaidi Ali , Talon Brian , Asfaw Alemseged Ayele , Zhou Jifang , Sharp Lisa K. , Sweiss Karen , Patel Pritesh Rajni , Chiu Brian C-H , Ko Naomi , Calip Gregory Sampang 
Published: May 2019

6582 Background: The strength of associations between pre-diagnosis self-reported health (SRH) and mortality differ by medical condition, with a moderately strong association reported among cancer patients. Less is known about the impact of SRH on survival among patients diagnosed with multiple myeloma (MM). We aimed to evaluate pre-diagnosis SRH in relation to survival in a cohort of older MM patients. Methods: We analyzed a prospective cohort from the Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database of patients 65 years and older diagnosed with first primary MM. Survey responses to a single general health question (asking patients to self-report their health as excellent, very good, good, fair, or poor) were used to determine pre-diagnosis SRH, grouped as high (excellent/very good/good) or low (fair/poor). We used multivariable Cox proportional hazards models to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for associations between SRH and risks of all-cause and cancer-specific mortality. Results: Of 521 MM patients with pre-diagnosis SRH data, the mean (SD) age at diagnosis was 76.8 (6.1) years with 60% of patients identifying as white, 18% as black, and 32% reporting low SRH. Compared to patients reporting high SRH, patients reporting low SRH were older, had lower education levels, more comorbidities, and lower Veterans-RAND 12 physical health and mental health component summary scores. In multivariable analyses, MM patients with low SRH had a 28% increased risk of all-cause mortality (HR = 1.28, 95% CI = 1.00, 1.64) and a non-statistically significant 19% increased risk of cancer-specific mortality (HR = 1.19, 95% CI = 0.87, 1.61) compared to MM patients reporting high SRH. Conclusions: Our findings suggest that lower SRH is highly prevalent among MM patients prior to diagnosis and is associated with modestly increased all-cause mortality. At a minimum, low SRH deserves clinical attention to determine how older MM patients’ quality of life may be compromised. The mechanism by which SRH affects mortality in MM should be further assessed and efforts should be made to identify whether any of the underlying mechanisms linking SRH and mortality in MM are mutable.