bluuebunny/crossref_metadata_2025_split huggingface dataset:
An intervention study to reduce black-white treatment disparities in early stage non-small cell lung cancer.
Authors: Walker Paul R. , Cykert Sam , Edwards Lloyd , Arya Rohan , Dilworth-Anderson Peggye 
Published: September 2018

6560 Background: Racial disparities in the treatment of non-small lung cancer (NSCLC) continue to exist leading to poorer outcomes in African-Americans (AA) compared to Caucasians (C). Our previous multi-institutional prospective cohort study of 386 patients identified a surgical rate in early stage NSCLC of 66% C but only 55% AA (p = 0.05; OR 0.75; 95% CI 0.57-0.99). (Cykert et al JAMA 2010) A 3 year retrospective chart review of all patients with early stage NSCLC at the 3 academic institutions involved in this current intervention study identified 714 patients with early stage NSCLC. Baseline surgical rates 69% for C and 66% for AA. Combined stereotactic body radiation therapy (SBRT) with surgery C 80% and AA 76%. Controlling for co-morbidities, COPD, age and other demographic data, the OR for surgery AA compared to C 0.64 (95% CI 0.43-0.96) and for combined surgery or SBRT AA compared to C 0.61 (95% CI 0.43-0.96). Methods: Patients with a stage I or II NSCLC were identified and randomized to each institution’s standard of care approach or to an ‘intervention’ component utilizing a trained navigator to enhance patient communication and treatment understanding. Results: 244 patients were prospectively recruited into this intervention study. Mean age 65.7 years; 54% women; 89 (34%) AA. The intervention group showed an overall surgical rate of 74% (74.8% C, 71.4% AA; p = 0.6). Combined treatment of either surgery or SBRT increased an ablative treatment to 91.9% for C and 94.1% AA patients (p = 0.5). Logistic regression was performed comparing the intervention group to the baseline group. Results showed that overall treatment improved for both C and AA, the surgical and overall treatment disparity between C and AA was no longer present, while age, COPD, and clinical stage remained significant predictors of treatment. Conclusions: A multifaceted intervention designed to enhance patient communication and treatment understanding removed the surgical and overall early lung cancer treatment disparity between AA and C. Clinical trial information: NCT01687738.
Disparities in prognosis communication among parents of children with cancer: The impact of race and ethnicity.
Authors: Ilowite Maya , Cronin Angel M. , Kang Tammy I , Mack Jennifer W. 
Published: September 2018

6562 Background: Most parents of children with cancer say they want detailed prognostic information about their child’s cancer. However, prior work has been conducted in populations of limited diversity. We sought to evaluate the impact of parental race/ethnicity on prognosis communication experiences amongst parents of children with cancer. Methods: We surveyed 357 parents of children with cancer, and the children’s physicians at Dana-Farber Cancer Institute/Boston Children’s Hospital and Children’s Hospital of Philadelphia. Our outcome measures were parental preferences for prognostic information, physician beliefs about parental preferences, prognosis communication processes and communication outcomes. Except where noted, associations were assessed by logistic regression with generalized estimating equations to correct for physician clustering. Results: 87% of parents wanted as much detail as possible about their child’s prognosis, with no significant differences by race/ethnicity (P = .50). Physician beliefs about parental preferences for prognosis communication varied based on parent race/ethnicity. 60% of physicians for White parents reported they believed parents wanted as much detail as possible about their child’s prognosis, versus 36%, 38%, and 64% of physicians, respectively, for Black, Hispanic, and Asian/Other parents (P = .04). Parent race/ethnicity was not associated with actual prognostic disclosure as reported by parents (P = .79) or by physicians (P = .61). Accurate understanding of prognosis was higher amongst White (51%) versus non-White parents (range 22%-29%), although this difference was not statistically significant (P = .13, unadjusted). Conclusions: The majority of parents, regardless of racial and ethnic background, want detailed prognostic information about their child’s cancer. However, physicians rarely recognize the information needs of Black and Hispanic parents. Despite this discrepancy, prognosis communication outcomes were largely equivalent. Our findings suggest that in order to meet parents’ information needs, physicians should ask about the information preferences of parents of children with cancer prior to prognosis discussions.
Miami NICE trial: Nutritional support for patients incurring chemotherapy side effects.
Authors: Hansra Damien Mikael , Diaz Catherine , Camp Skip , Randolph Caroline , Norman-Tiner Christine , Antunez de Mayolo Jorge 
Published: September 2018

6568 Background: Few studies have been performed addressing nutritional interventions & mitigation strategies to address side effects such as weight gain, anorexia, dysgeusia, in patients (pts) undergoing chemotherapy. We aim to study the effect of nutritional counseling on body mass index (BMI) and other side effects in pts undergoing systemic chemotherapy. Methods: Prospective randomized study of 50 pts into two groups (A & B). Group A was randomized to standard of care: oncologist visits once per month x 3 months, routine physician counseling & dietary recommendations. Group B: standard of care + nutritionist intervention which included 3 visits x 30 mins each. Nutritionists performed an initial assessment of pts at the first session (template provided in poster) then tailored dietary counseling monthly x3 months which includes dietary strategies to mitigate side effects, pt & caregiver education, recipes, & handouts (provided in poster). Inclusions: medically insured male & female adults with active malignancies (hematologic &boncologic) on chemotherapy (neoajuvant, adjuvant, palliative). Exclusions: pts with head & neck, stomach, esophagus, pancreatic tumors & pts with pre-existing cachexia. Data collected: pt gender, age, race, ethnicity, cancer subtype, TNM staging, chemotherapy regimen. Primary objective: compare change in BMI at visit 1, 2, &3. Secondary endpoints: anorexia, nausea, vomiting, depression, etc. reported in poster. Mean change in BMI, secondary endpoints compared using students T-test with ANOVA using SAS software version 8.0 & minitab version 17. Results: Group A initial BMI = 28.85 vs group B initial BMI = 27.34 (p = 0.05). Change in BMI group A vs B at visit 1 (0.4 vs 0.09, p = 0.002), visit 2 (4.6 vs -0.52, p = 0.001), visit 3 (6.5 vs 0.46, p = 0.003). Demographics & secondary endpoints reported in poster. Conclusions: We found dietary counseling in addition to standard of care was associated with significant mitigation of weight gain in patients on systemic chemotherapy. Dietary counseling is a relatively simple, inexpensive, individualized, & reproducible method to mitigate chemotherapy related weight gain.
Prospective assessment of psychosocial outcomes of contralateral prophylactic mastectomy.
Authors: Brewster Abenaa M. , Peterson Susan K. , Bedrosian Isabelle , Thompson Alastair Mark , Black Dalliah MaShon , Nelson Jonathan , Cook Robert , DeSnyder Sarah Marie , Hunt Kelly , Cantor Scott B. , Volk Robert Joseph , Dong Wenli , Parker Patricia A. 
Published: September 2018

6569 Background: Increasing numbers of women are choosing contralateral prophylactic mastectomy (CPM) despite the lack of knowledge about its effect on long-term psychosocial adjustment. The objective of the study was to examine patient-centered psychosocial outcomes of women with breast cancer who have CPM versus those who do not in order to enhance shared surgical decision making. Methods: We enrolled 308 women with newly diagnosed, non-hereditary breast cancer prior to surgery (CPM or no CPM) at MD Anderson Cancer Center and Kelsey-Seybold Clinic between 2012 and 2015. Women completed validated questionnaires assessing psychosocial factors including quality of life (QOL), body image concerns, cancer distress, trust in physician and decision satisfaction pre-surgery and at 1, 6 and 12-months post-surgery. Repeated measures models were fitted to assess the association between psychosocial outcomes measured at each time point and CPM status adjusting for time effect. Results: Among 252 women (mean age 56) who completed pre and post-surgery questionnaires, 60% were non-Hispanic white, 16% non-Hispanic black, 16% Hispanic, 8% mixed race and 17% had CPM. Women who had CPM had higher scores for cancer distress and body image concerns and lower scores for QOL than women who did not have CPM at pre-surgery (p = 0.04, p < 0.01, p = 0.20, respectively), and at 1 month (p = 0.42, p < 0.001, p < 0.01, respectively), 6 months (p = 0.03, p < 0.001, p = 0.05, respectively) and 12 months (p = 0.01, p < 0.001, p = 0.01, respectively) post-surgery. After adjusting for time effect, women who had CPM had higher post-surgery scores for cancer distress (p = 0.03), body image concerns (p < 0.0001), QOL (p < 0.01) and lower trust in physician (p = 0.03) than women who did not have CPM. There was no statistically significant difference by CPM status for cancer knowledge or decision satisfaction. Conclusions: This is the first study to demonstrate that psychosocial factors such as cancer distress, QOL and body image concerns are not improved by having CPM. The results highlight the importance of evaluating psychosocial factors pre- and post- surgery and the need to incorporate psychosocial assessment and counseling in the CPM decision making process.
Understanding the non-curative potential of palliative chemotherapy: Do patients hear what they want to hear?
Authors: Enzinger Andrea Catherine , Wind Jen , Frank Elizabeth , McCleary Nadine Jackson , Cronin Christine , Sanoff Hanna Kelly , Van Loon Katherine , Matin Khalid , Bullock Andrea J. , Meropol Neal J. , Uno Hajime , Schrag Deborah 
Published: September 2018

6575 Background: Misconceptions about the curative potential of PC are common, and may arise from gaps in informed consent. Another contributing factor could be patients’ desire, or lack of desire, for information about prognosis and PC outcomes. Methods: We surveyed 137 patients with advanced colorectal (N = 102) or pancreatic cancer (N = 35) within 2 weeks of consultation about 1st or 2ndline PC, as part of randomized trial of a PC education intervention at 6 US sites. Patients rated how much information they wanted about PC risks/benefits, including impact on prognosis. Responses ranged from no information to as much as possible on a 5-point Likert scale. They reported decision-making preferences; whether a doctor discussed curability, and how likely they thought PC was to cure their cancer. Chi square and Wilcoxon tests examined whether information and decision-making preferences, or curability discussions were associated with expectations of cure. Multivariable logistic regressions evaluated whether associations were modified by age, race, gender, marital status, or cancer type. Results: Only 44.5% of patients accurately reported that their cancer was not at all likely to be cured by PC. Most patients wanted a lot, or as much information as possible about PC risks/benefits, including likelihood of cure (81.7%), cancer control (84.7%), and impact on length of life (80.3%). Most patients preferred shared (70.8%) versus active or passive decision-making. Neither decision-making nor prognostic information preferences were associated with expectations of cure. Patients (13.9%) who did not recall curability discussions were less likely to have accurate expectations (21% v 48%; OR, 0.29; 95% CI, 0.07-.97). Patient characteristics did not significantly confound this association. Conclusions: Most patients value shared decision-making and want maximal information about PC risks/benefits, including impact on prognosis. Despite wanting prognostic information and reporting curability discussions, many patients report inaccurate expectations about cure from PC. Future studies should examine whether these assertions reflect misunderstandings, differences in belief, or expressions of hope.
Prophylactic anticoagulation to benefit younger patients under 65 years of age with metastatic lung cancer: An analysis of the 2013 Healthcare Cost and Utilization Project (HCUP) data.
Authors: Bagchi Arindam , Iyer Veena , Hamouda Danae , Nai Qiang , Khuder Sadik , Verghese Cherian 
Published: September 2018

6581 Background: Cancer patients have increased risk of venous thromboses. Venous thromboembolism (VTE) is reported to be a leading cause of death in cancer patients. It has been hypothesized that prophylactic anticoagulation for VTE might improve prognosis and quality of life. Based on our analysis of the 2013 HCUP data, we propose that prophylactic anticoagulation should be considered for patients younger than 65 years with metastatic lung cancer. Methods: Patients were selected using ICD-9 diagnoses codes for metastatic lung cancer and VTE. Diagnoses were stratified by site including upper extremity, lower extremity, pulmonary, abdominal and nonpulmonary thoracic VTE. Patients were stratified by age, sex, race and ethnicity. Differences in incidence of VTE among groups were calculated by the Chi-Square method using the SAS software. Results: There were a total of 16,577 VTE events amongst 182,863 cases of metastatic lung cancer. Subgroup analyses showed that patients younger than 65 years of age had 356.82 more PE events per 100,000 individuals compared to those at or older than 65 years (p < 0.0001). The same age group also showed 374.83 more UE, 286.94 more nonpulmonary thoracic and 263.97 more abdominal (Abd) VTE events per 100,000 individuals (p-values, p < 0.0001). There was no statistically significant difference in the incidence of LE VTE’s between the subgroups. Conclusions: Prophylactic anticoagulation should be considered in patients < 65 years of age with metastatic lung cancer. Increased incidence of VTE in these patients may contribute towards greater morbidity and mortality associated with metastatic lung cancer in this subgroup. [Table: see text]
Patterns in provider types and cost of surveillance testing in early-stage breast cancer patients: A regional study.
Authors: Lyman Gary H. , Fedorenko Catherine R. , Walker Julia Rose , Panattoni Laura Elizabeth , Greenlee Stuart , Kreizenbeck Karma L. , Greenwood-Hickman Mikael Anne , Barger Sarah , Blau Sibel , McGee Richard A. , Conklin Ted , Smith Bruce , Ramsey Scott David 
Published: September 2018

6582 Background: Although ASCO Choosing Wisely guidelines recommend against routine surveillance testing or imaging for asymptomatic individuals with early-stage breast cancer (ESBC) treated with curative intent, they are frequently performed. Physician specialty and costs associated with surveillance testing and imaging were examined in ESBC patients. Methods: Cancer registry patient records in Western Washington from 2007 to 2015 were linked with claims from two regional commercial insurers. Selected patients had been diagnosed with stage I/II breast cancer and treated with mastectomy or lumpectomy + radiation. Surveillance was considered from the first 4 month gap in treatment (surgery, chemo, radiation) through 13 months or restart of treatment. Evaluation and Management (E&M) and procedure codes for tumor marker (CEA, CA 15-3, CA 27.29) and advanced imaging (PET, CT, bone scan) were identified. Specialty codes were used to determine provider type. Physician visits were matched to tests using E&M codes in the +/- 7 days around each test. Cost included total reimbursed amount from insurers during the surveillance period. Results: During surveillance, 2,193 patients averaged 13.3 physician visits [median: 11, IQR: 8-17]. Oncologists (91%) and PCPs (83%) were the most common specialties with an average of 3.7 visits each. Overall, 37% of patients received tumor marker tests (avg = 2.8 tests/patient) and 17% received advanced imaging (avg = 1.5 images/patient). The mean total cost during the surveillance period was $18,403 (SD $26,640). Costs were higher for those patients who received tumor marker testing or advanced imaging. Conclusions: Patients frequently see oncologists and PCPs during early surveillance. Targeting oncologists to improve appropriate tumor marker testing could have the largest impact on aligning practice with Choosing Wisely recommendations and potentially reducing the financial burden on patients. [Table: see text]
Transparency around disapproval reasons of early-phase trial proposals submitted to the National Cancer Institute (NCI).
Authors: Massett Holly A. , Gravell Amy , Waters Brittany , Mishkin Grace , Denicoff Andrea , Ivy S. Percy , Moscow Jeffrey , Zwiebel James A. , Montello Michael , Abrams Jeffrey S. 
Published: September 2018

6585 Background: NCI’s ETCTN accepts Letters of Intent (LOI) for a new clinical trial either from a response to a solicitation for studies, or via unsolicited LOIs, where investigators independently propose novel studies. While the LOI approval rate for the first two years of the ETCTN was 100% for solicited LOI’s, it was only 36% for unsolicited LOIs. Therefore, we analyzed all ETCTN LOI disapproval letters (DL) for unsolicited LOIs to identify the major reasons for disapproval. Methods: A content analysis was conducted on DLs issued between March 2014 and March 2016 (N = 50). Two coders independently scored disapproval reasons per letter using a code sheet with 22 categories identified from a sample of DLs (Intercoder Reliability = 97%). Results: All DLs were issued for unsolicited LOIs (44% = Ph 1; 26% = Ph 1/2; 30% = Ph 2); 271 reasons were identified across the 50 DLs (mean = 5.4/DL). High-level categories included concerns with study design, scientific rationale, feasibility, modality and administrative reasons. The top disapproval reasons were: Insufficient preclinical animal model data (54% of DLs); weak rationale/background (52%); inadequate information for biomarker correlative studies (46%); dose/scheduling plan absent or weak (36%); clinical data not adequately advanced (34%); and, patient population not described/inconsistent with treatment (34%). Top reasons for Phase 1 and 1/2 LOIs resembled the total but Phase 2 LOIs deviated slightly, with ‘weak objective/endpoint’ and ‘biomarker correlative studies’ as top DL reasons. Other common reasons were problems with combination study agents, company/drug collaboration, and competing trials. Conclusions: The reasons for LOI disapproval can be categorized and quantified. To increase transparency in the NCI ETCTN LOI review process, disapproval reasons for each DL are now collected on a standardized coding sheet, and will be reported quarterly to ETCTN PIs. NCI will also meet with all Grant PIs in Spring, 2017 to jointly discuss concerns and explore quality improvement solutions regarding the LOI submission process. The outcome of this meeting will be reported at ASCO as part of our findings.
Physician volume and discontinuation of rituximab during lymphoma treatment.
Authors: Huntington Scott F. , Long Jessica B. , Hoag Jessica R. , Wang Rong , Zeidan Amer M , Giri Smith , Gore Steven , Ma Xiaomei , Gross Cary Philip , Davidoff Amy J. 
Published: September 2018

6593 Background: Despite the high complexity of cancer therapies, studies evaluating provider-level volume and outcomes of systemic treatments are lacking. As rituximab was the first approved monoclonal immunotherapy, and has the potential for severe infusion reactions, we hypothesize that low provider volume is associated with early rituximab discontinuation. Methods: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results -Medicare data.Individuals 66+ years old with B cell non-Hodgkin lymphoma (NHL) diagnosed during 2004-2011 and 1+ rituximab claims were included. A provider was assigned to each patient-rituximab initiation using Medicare claims. We used a 12-month lookback from each initiation to categorize provider volume (0, 1-2, or 3+ rituximab initiations) in the prior year. Our primary outcome was early discontinuation, defined as receipt of 1-2 rituximab cycles within 180 days of initiation. We used a modified Poisson regression to account for provider level correlation and estimated the relative risk of early discontinuation in patients with 6+ months of follow up after rituximab initiation. A Cox proportional hazards model was used to measure the impact of discontinuation on overall survival. Results: A total of15,110 patients (median age: 75 years) initiated rituximab with 2,684 providers. The majority (70.4%) initiated rituximab in conjunction with chemotherapy and 1,146 (7.6%) experienced early rituximab discontinuation. Provider experience with rituximab during the previous 12 months was associated with early discontinuation in a dose-dependent manner (adjusted relative risk [aRR]: 1.57, [95% confidence interval [CI]:1.35-1.83], p < .001 for 0 vs 3+ initiations; aRR: 1.19 [95% CI:1.03-1.37], p = .02 for 1-2 vs. 3+ initiations). In addition, rituximab discontinuation was associated with a higher risk of death (adjusted hazard ratio: 1.39 [95% CI:1.28-1.52], p < .001). Conclusions: Lower physician volume is associated with increased risk of early discontinuation in older adults initiating rituximab for NHL. Due to the association between early discontinuation and mortality, physician volume may be an important factor in providing high quality NHL care.
Patient safety: A progressive deprescribing model in patients with advanced solid tumors assisted at Instituto Oncológico Henry Moore (IOHM).
Authors: Gil Deza Ernesto , Morgenfeld Eduardo L. , Rivarola Edgardo G. J. , Muino Marcelo , Garcia Gerardi Carlos Fernando , Tognelli Flavio , Abal Mariana , Ares Sandra L. , Montiel Monica , Gercovich Felipe G. 
Published: September 2018

6594 Background: "Deprescribing is the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes" ( Br J Clin Pharmacol 80:6, 1254. 2015). The aim of this paper is to present a model for deprescribing used at IOHM. Methods: Between 09/26/2012 and 09/26/2016, 10,053 pt filled out a Past Medical History Form, listing all the medications they were taking regularly. We selected all the pt. with advanced solid tumors (AST). In each pt the expected survival was established in order to evaluate the usefulness of the Tx. The drugs were classified in three groups: A) Green: Adequate (must be maintained); B) Yellow: Questionable (could be maintained or removed) or C) Red: Avoidable (must be removed). Results: We registered 2,103 pt who met the inclusion criteria. Sex F/M: 905 /1198. Median age 63 y (r = 19-99). A total of 1,629 pt. (77%) were taking medications on a regular basis. The total amount of medications was 5,679 . Median medications per patient: 3 (range: 1-14). Eighty percent of the pt (1,298 pt) were receiving questionable of avoidable medications. The following table shows the distribution of medications per group. Conclusions: A) In this cohort of 2,103 pt with AST, half of them had an average life expectancy of less than one year. B) 1,298 out of 1,629 pt (80%) were receiving a questionable medication C) 596/5,769 (10%) of the registered drugs, had to be suspended immediately and at least a thousand more could be eliminated. d) Obstacles to deprescribing were essentially medical ignorance, fear and inexperience. [Table: see text]