bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of dual anti-HER2 therapy on pathologic complete response rate in breast cancer in a minority-enriched population.
Authors: Li Jenny Jing , Li Hsiao Ching , Gao Ang , Syed Samira K. , Unni Nisha , Sadeghi Navid 
Published: May 2019

e18111 Background: The addition of pertuzumab (P) to a neoadjuvant trastuzumab (H) plus chemotherapy combination has been shown to significantly improve the pathologic complete response rate (pCR) in localized HER2+ breast cancer; however, minorities have been under-represented in these trials. Racial/ethnic disparities have also been shown to affect outcomes of cancer treatment. This study is aimed to assess the impact of neoadjuvant dual HER2-blockade in an unselected minority-enriched population. Methods: A retrospective chart review was conducted of women with stage I to III HER2+ breast cancer who received neoadjuvant treatment between 2007 and 2017 at an academic institution and its affiliated safety net health system. Data on stage, chemotherapy, race/ethnicity, site of therapy (academic vs safety net hospital), and hormone receptor status were collected. All patients underwent surgery after completion of neoadjuvant chemotherapy. pCR was defined as ypT0/is, ypN0. Chi-squared test and univariate/multivariate logistic regression were used for statistical analysis. Results: The study population included 261 women with the following race/ethnic distribution: 37.7% Non-Hispanic Whites, 34.6% Hispanics, 20.6% Blacks, and 7% other racial/ethnic origin. Ninety-five patients (36%) received chemotherapy-H vs 166 patients (64%) received chemotherapy-HP. Patients at the safety net health system had higher stage at diagnosis compared to the academic site. Site of care and race/ethnicity did not impact the choice of neoadjuvant treatment. The pCR rate was significantly higher for the chemotherapy-HP group (55.4%) compared to the chemotherapy-H group (34.7%) (p = 0.001). There was no association between race/ethnicity, or site of treatment (academic vs safety net), and the probability of achieving pCR. Multivariate analysis showed only dual anti-HER2 therapy (OR: 2.67, CI: 1.55-4.59, p = 0.0004) and hormone-receptor negative status (OR: 2.18, CI: 1.30-3.67, p = 0.0031) to correlate with pCR. Conclusions: Neoadjuvant dual anti-HER2 therapy was more likely to result in a pCR in our minority enriched population. Our data also suggests the combination of chemotherapy-HP confers similar benefit irrespective of race/ethnicity or site of care.
Contextualizing place and health in rural America: Cancer information seeking across four categories of an urban/rural continuum.
Authors: Lopez Gilberto , Mattie Heather , Culakova Eva , Lin Po-Ju , Kamen Charles Stewart , Janelsins Michelle Christine , Morrow Gary R. 
Published: May 2019

e18124 Background: Cancer is the second leading cause of death in the United States. Despite decreases in cancer mortality overall, rural populations continue to have higher prevalence and slower reduction of cancer death rates. As a preventive approach to combat cancer, the National Cancer Institute continues to prioritize providing the public with health information. Yet, little is known about cancer information-seeking across rural America. Methods: Using Rural-Urban Commuting Area Codes (RUCAs), from the 2018 Health Information National Trends Survey (HINTS-5) database we analyze the odds of looking for information about cancer across four geo-political contexts (n = 2,625): urban, large-rural, small-rural, and isolated-rural areas, thus giving us a potentially more detailed understanding of place and health across the urban-rural continuum. Using an established social determinants framework, a series of logistic regression models were fitted to estimate odds ratios (OR) and 95% confidence intervals (CIs). Results: Across all models, those living in large rural towns had about 1.5 times the odds of looking for cancer information compared to urban-dwellers (p < 0.05) while those living in remote rural areas had about 0.5 times the odds (p < 0.05). There was no difference for those living in small rural towns. Additionally, gender, race/ethnicity, marital status, education, housing status, and internet availability were independently associated with information-seeking (p < 0.05). Conclusions: In this study, compared to urban-dwellers, those living in large rural towns appeared to have increased odds of looking for cancer information while those living in isolated rural areas had decreased odds. Understanding this relationship between place and health has implication for the allocation of resources and the design of interventions aimed at increasing information about cancer.
Impact of the Affordable Care Act on insurance for adolescents and young adults with cancer.
Authors: Winestone Lena , Hochman Lauren , Sharpe James , Alvarez Elysia Marie , Becker Laura , Chow Eric Jessen , Fish Jonathan D. , Reiter Joseph , Ginsberg Jill P. , Silber Jeffrey H. 
Published: May 2019

e18125 Background: The 2010 Dependent Coverage Provision (DCP) of the Affordable Care Act (ACA) allowed young adults to remain on their parents' health insurance until age 26 years (y), whereas pre-DCP the cut-off varied, but was most often 18 y. Our objective was to compare rates of insurance disenrollment among patients with cancer who were DCP-eligible compared to those who were not. Methods: A retrospective cohort from the OptumLabs Data Warehouse, which includes claims data for privately insured enrollees in a large US health plan, was used. Patients born between 1982-93 diagnosed with cancer between 2000-15 were included. In the Recent Cohort, patients who turned 19 in 2010-12 (who were always eligible to stay on parents’ insurance) were matched to patients who turned 19 in 2007-09 (who were not protected by the DCP when they turned 19). Sensitivity analyses paired patients in an Earlier Cohort, who turned 19 (in 2001-03 and 2004-06), none of whom were eligible for the DCP when they turned 19. Patients were matched on cancer type, diagnosis date, and additional clinical characteristics. Using a time to loss of coverage analysis (defined as > 90 d interruption in insurance enrollment), hazard ratios (HR) were calculated using Cox proportional hazards models. Difference-in-difference between pairs from the Recent and Earlier cohorts was evaluated. Results: Of the 3,013 patients who turned 19 in 2010-12, 2,829 were matched. Median time to disenrollment was 26 months (m) compared to 22 m among patients who turned 19 in 2007-09 (HR 0.88, 95% CI 0.81-0.95, p = 0.0009). In the 4,489 pairs of patients who turned 19 between 2001-06, median time to disenrollment was 20 m among both the younger and older patients in the pair (p = 0.047). In grouped analyses, the difference-in-difference between the Recent and Earlier sets of pairs displayed a 14% reduction in the hazard for losing coverage (p < 0.0001), favoring those who turned 19 after DCP became available. Conclusions: In pediatric cancer patients and survivors, a vulnerable population that needs continuous insurance coverage, these data suggest that the DCP of the ACA lowers the insurance drop-out rate.
Association of state Medicaid expansion with timeliness of cancer care delivery.
Authors: Takvorian Samuel U , Bekelman Justin E. , Mamtani Ronac , Shulman Lawrence N. , Werner Rachel M. 
Published: May 2019

e18126 Background: The Affordable Care Act (ACA) expanded Medicaid eligibility to nonelderly adults with incomes at or below 138% of the federal poverty level in participating states. Medicaid expansion has been associated with earlier cancer stage at diagnosis; however, its impact on cancer treatment is unknown. Methods: We assembled retrospective cohorts of adult nonelderly patients (ages 40-64) with newly diagnosed breast, colon and lung cancer from January 2011 to December 2015, using data from the National Cancer Database (NCDB). We conducted a quasi-experimental, difference-in-differences analysis to compare Medicaid expansion and non-expansion states on timeliness of cancer therapy, stage at diagnosis, and insurance status for the years before (2011-2013) and after ACA Medicaid expansion (2014-2015). Results: There were 466,314 patients in expansion states (mean age, 54.7 years; 81.5% women) and 487,958 patients in non-expansion states (mean age, 54.9 years; 78.5% women). In expansion states relative to non-expansion states, there was no significant difference in the proportion of patients initiating cancer therapy within 30 days (adjusted difference-in-difference (DID) estimate -0.1%; 95% CI -0.8 to +0.7%, p = 0.868) or within 90 days of diagnosis (adjusted DID estimate -0.1%; 95% CI -0.3 to +0.1%, p = 0.501), before and after expansion. Among those with early-stage cancers undergoing definitive therapy, there was similarly no significant difference in time to treatment. Relative to non-expansion states, the proportion of early stage cancer diagnoses increased more (adjusted DID estimate +0.7%; 95% CI +0.3 to +1.2%, p = 0.002), and the proportion of advanced stage cancers decreased more (adjusted DID estimate -0.4%; 95% CI -0.7 to -0.1%, p = 0.008) in expansion states. The proportion uninsured at diagnosis decreased more in expansion states (adjusted DID estimate -0.8%; 95% CI -1.2 to -0.4%, p < 0.001). Conclusions: Among nonelderly patients with common cancers, ACA Medicaid expansion was associated with an increase in the proportion of cancers diagnosed at early stage, a decrease in the proportion of cancers diagnosed at advanced stage, and a decrease in the proportion of uninsured. There was no significant effect on the timeliness of treatment.
Which social measures relate to cancer screening & healthy behaviors?
Authors: Fei Kezhen , Cruz Daliz , Lin Jenny J. , Yagnik Radhi , Gallagher Emily , Bickell Nina A. 
Published: May 2019

e18142 Background: Much of cancer health services research relies on administrative data, yet, there have been calls for more granular racial & social disparities data. Subjective SES (sSES) is associated with health status & behaviors, independent of objective SES (oSES) measures like income, education and race. We assessed the relationship between breast cancer patients’ oSES and sSES with their cancer screening and health behaviors. Methods: Data are part of a large prospective study evaluating the role of insulin resistance in women with newly diagnosed breast cancer. Patients were asked to place where they stand in their communities on the MacArthur Scale of Subjective Social Status ladder (sSES). oSES measures include race, income & education. We assessed diet, activity, breast & pap screening. Group comparisons used chi-square and t-tests as appropriate. We ran logistic multivariate models with age, race, insurance, comorbidity & income. Results: Of 1035 breast cancer patients with an average age of 58±12 yrs, 81% were White and 19% Black, 63% graduated college, 47%W & 16%B women reported an income of > $100,000/yr. The median sSES = 8; 20% had high sSES ( > 8). There were no racial differences observed in sSES (high sSES: 22% B vs 20% W; p = 0.7). More patients with high sSES graduated college (76% vs 61%, p = 0.0002) & had income > $100K/yr (62% vs 36%, p < .0001) than patients with lower sSES. Of the oSES, women with higher income were more likely to undergo both cancer screenings as compared to patients with lower income. College education did not impact cancer screenings. Black women were less likely to get pap smears. Patients with high as compared to low sSES had higher cancer screening rates and healthy behaviors. Conclusions: Income and sSES are positively associated with cancer screening and health behaviors; education & race are associated with activity & diet. Race is associated with pap screening.[Table: see text]
FDA analysis: Demographic trends in bladder and renal cancer trials.
Authors: Fernandes Laura L , Lin Zhantao , Fashoyin-Aje Lola A. , Tang Shenghui , Sridhara Rajeshwari , Pazdur Richard 
Published: May 2019

e18144 Background: Many publications report under representation of minorities in certain subgroups, which may limit the generalizability of clinical trial (CT) results. This analysis, investigates and reports enrollment trends in CTs submitted between 2006-2017 in support of marketing applications for drugs indicated for the treatment of urothelial (UC) and renal cancer carcinoma (RCC), and compares them to incidence rates of these diseases by Surveillance, Epidemiology, and End Results (SEER) registry and the US census bureau. Methods: We identified all marketing applications for the treatment of UC and RCC that provided the primary evidence of safety and efficacy and aggregated the demographic data across trials and disease. Using these two pooled datasets, we compared the patient proportions enrolled in each of the race, sex and age categories to the corresponding rates in US cancer population estimated based on the corresponding incidence rates reported by SEER and the US census bureau using a Chi-squared test. Results: The pooled seven UC and 14 RCC CTs provided 2035 and 6757 patients respectively. The results are summarized below for the 939 (46%) UC and 1489 (22%) RCC patients enrolled in the US. Conclusions: Our findings indicate that majority of the patients were enrolled outside of the US. There were lower proportion of Black patients (4% vs 8%), older patients, age ≥ 75 years (30% vs 48%) and males (74% vs 80%) enrolled in UC population in the US. Higher proportions were observed in both White (89% vs 85%) and Asian (4% vs 2%) patients in UC and in White (90% vs 79%) patients in RCC.[Table: see text]
Body composition change, safety, and efficacy with everolimus use in ethnic minorities with breast cancer.
Authors: Kaur Gurbakhash , Podolski Amanda , Patel Janki , Anampa Mesias Jesus Del Santo 
Published: May 2019

e18145 Background: The mammalian target of rapamycin (mTOR) signaling pathway regulates metabolism and is implicated in pathological conditions including obesity and diabetes. In obese rat models, mTOR inhibition was shown to ameliorate obesity and adipocyte hypertrophy, while exacerbating glucose intolerance. The mTOR inhibitor Everolimus (E), in combination with exemestane, is FDA approved for the treatment of ER+/HER2- metastatic breast cancer (MBC) with hyperglycemia being common toxicity. There is scarce data about the safety & efficacy of E in ethnic minorities. We aimed to assess the effect of E on body composition after 3 & 6 months and to describe toxicity & efficacy in ethnic minorities. Methods: A retrospective study involving patients with MBC treated with E between 1/1/2012-12/1/2018. Total fat area (TFA), visceral fat area (VFA), subcutaneous fat area (SFA), muscle area (MA), and muscle density (MD) were measured before and after 3 & 6 months of E treatment using CT images at the L3 vertebrae. Results: Our cohort included 58 patients with a median age of 69 years (range: 46-97); 22% were Caucasian, 35% were black, and 41.4% were Hispanic. Visceral disease was present in 64%, the median number of prior endocrine therapies was 2 (range: 1-6), and the median number of prior chemo lines was 2 (range 1-7). There was significant decrease in body weight at month 3(-2.9kg, p < 0.0001) and month 6 (-5.2kg, p = 0.006). At month 3, there was a significant decrease in TFA (-2848 mm2, p = 0.004), VFA (-834 mm2, p = 0.004), and SFA (-2021 mm2, p = 0.002), with similar effects at month 6. When compared to baseline, there was no significant change in MA or MD at month 3 or 6. Grade 3/4 adverse events (AEs) were present in 18 patients. The most common AEs were mucositis (22%), rash (21%), fatigue (14 %), hyperglycemia (10%), diarrhea (9%), pneumonitis (9%), and edema (7%). The median PFS was 5.8 months. Conclusions: This is the first report that Everolimus treatment decreases body weight, TFA, VFA, and SFA without significant effect on MA or MD. Our findings are consistent with animal models reports that mTOR inhibition causes a decrease in fat mass in obese rats. We report the median PFS of 5.8 months in a cohort with ethnic minorities.
Racial differences in intravenous bisphosphonate utilization among older patients with multiple myeloma.
Authors: Zhou Jifang , Sweiss Karen , Patel Pritesh Rajni , Nutescu Edith , Ko Naomi , Chiu Brian C-H , Calip Gregory Sampang 
Published: May 2019

e18165 Background: Intravenous bisphosphonates (IV BP) reduce the risk of skeletal-related events in patients with multiple myeloma (MM). However, data describing racial differences in utilization of IV BP in non-clinical trial settings is limited. In this study, we evaluated population-level IV BP utilization and factors associated with initiation and discontinuation of IV BP therapy. Methods: We conducted a retrospective cohort study of patients aged 65 years or older diagnosed with first primary MM between 2001 and 2011. Patients were identified using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database and followed through December 2013. Patients were required to have Medicare Parts A and B coverage and patients with end-stage renal disease were excluded. Treatment with anti-MM therapy (chemotherapy and/or proteasome inhibitors) were treated as time-dependent variables. We analyzed cumulative incidences of IV BP initiation from the diagnosis of MM for all patients and separately time to discontinuation from IV BP initiation. In multivariable Fine and Grey models accounting for competing risks, we estimated subdistribution hazard ratios (SHR) and 95% confidence intervals (CI) for initiation and discontinuation. Results: 14,231 eligible patients had a mean [median] age of 76.8 [76] years and 51.8% were male. During a median follow-up of 23.1 months, 53.7% of patients received at least one intravenous bisphosphonate (IV BP) administration. IV BP initiation, duration and treatment frequency differed between racial groups. Among white patients, 64.4% of IV BP were administered every 4 weeks, compared to 59.3% in African Americans, 62.7% in Hispanic, and 64% in Asians. In multivariable models, Black patients experienced a significant delay in IV BP initiation (SHR 0.75, 95%CI 0.70-0.80) and were more likely to have early discontinuation (SHR 1.08, 95%CI 1.00-1.17). Conclusions: Despite recommended therapy with IV BP for MM patients, approximately half of older patients did not receive the therapy, with a significant lag experienced among racial minority groups. Efforts to improve uptake of IV BP and continued management of therapy in minority groups are needed. [Table: see text]
Valuing innovations in cancer treatment.
Authors: Zhao Henu , Tysinger Bryan , Goldman Dana P 
Published: May 2019

e18176 Background: Established in 2004 by voter referendum, the California Institute for Regenerative Medicine funds stem-cell research aimed at reducing the burden of diseases, including cancer. Incidence for certain cancer has been reduced by half in the last decades. To better understand the social benefit of medical innovation, we estimate the potential value of interventions to reduce the incidence of selected cancers. Methods: We use the Future Elderly Model (FEM) to simulate scenarios calculating the national and California disease burden of breast, colorectal, lung, and prostate cancer and the societal value of reducing incidence of these cancers by 10% and 50%, respectively. FEM is a well-validated microsimulation model of Americans aged 51 and older that projects future health and economic outcomes for individuals. Starting with a nationally representative sample from the Health and Retirement Study, we estimate two-year transitions between chronic diseases, functional status, and economic outcomes. We predict EQ-5D scores and quality-adjusted life-years (QALY) based on the outcomes and models using Medical Expenditure Panel Survey data. We then aggregate individual results to generate outcomes at the societal level. Results: Social values are measured by QALY, with each unit valued at $150,000. Yearly discount rate for future QALY is 3%. Estimated gains in aggregate social value from 2018 to 2050 are presented below. For the selected cancers, the disease burden of the selected cancers through 2050 ranges from $1.3 trillion to $3 trillion for the U. S. population >50. QALY gains from a 50% reduction in incidence are estimated at $0.5 trillion to $1.4 trillion, while gains from a 10% reduction are $110 billion to $252 billion. Conclusions: A small incidence reduction can result in large returns. There is a lot of potential for innovation in cancer. [Table: see text]
Do oral antineoplastic treatment data differ between Concerto Health AI Definitive Oncology EMR and Symphony Claims Data?
Authors: Chu Laura Kay , Chaudhary Nayan , Chen Li , Wong William Bruce 
Published: May 2019

e18180 Background: Electronic Medical Records (EMRs) are increasingly being used for health outcomes research because they contain a rich array of clinical data. Oral medications are captured via structured medication order fields or abstracted from the clinical notes; however, it’s unknown how these correspond with dispensations. The objective of this study was to better understand how oral antineoplastic orders captured from an EMR database compare to dispensations from pharmacy claims. Methods: The Concerto Health AI Definitive Oncology Dataset is a deeply curated cohort of patients (pts) derived from a wide range of oncology practices throughout the United States. Concerto Health AI has a co-exclusive partnership with ASCO CancerLinQ & collects data from multiple other sources. These data were deterministically linked to US Symphony Health’s (SH) Integrated Dataverse, an anonymized, HIPAA-compliant data set. Only advanced (stage IIIb/IV) non-small cell lung cancer (aNSCLC) pts with curated data via manual review by nurse practitioners & oral antineoplastics prescribed for lung cancer were included in this analysis. Among a subset of pts that had a dispensation within 90 days of their 1st EMR order, treatment duration was calculated as time from 1st to last order/claim (before a 30-day gap) plus 30 days supply, for EMR & claims, respectively. Results: Of 19,175 aNSCLC pts from Concerto, 8,864 pts were linked to SH. Among linked pts, there were 2,057 pt-drug instances; 750 (36.5%) were in both Concerto and SH, 1,160 (56.4%) in Concerto but not SH, and 147 (7.1%) in SH but not Concerto. Median time from 1st order in Concerto to 1st dispensation in SH was 16 days (interquartile range (IQR): 6, 78), with 76% of pt-drug instances having a dispensation within 90 days of 1st Concerto order. Median treatment duration was 44 (IQR: 30, 125) and 93 (IQR: 41, 241) days based on Concerto and SH, respectively. Conclusions: Concerto EMR orders identified more pts treated with oral antineoplastics, though treatment durations were longer using SH claims. Limitations of this analysis include use of orders from EMR instead of abstracted start and end dates and use of open claims with limited specialty pharmacy data. Linked datasets may provide more robust capture of orals data and warrant further research.