bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cancer patients experiencing homelessness: What’s happening to them?
Authors: Bingham Brian Stewart , Facer Benjin , Ivey Camille , Osmundson Evan 
Published: May 2019

e18153 Background: Over three million people in the United States of America (USA) experience homelessness each year. Homeless patients have high rates of cancer risk factors, later stage diagnoses, and increased rates of cancer death. Despite this, little is known about the treatment of homeless patients with cancer. General recognition exists that homelessness is accompanied by socioeconomic challenges, but their effect on cancer treatment is unknown. This analysis identifies published data on cancer care in homeless populations and evaluates the difference in information volume related to screening and treatment. Methods: A PubMed, MEDLINE, and Web of Science search was performed using combinations of: “homeless, homeless persons, homelessness, street people, neoplasm, neoplasia, tumor, malignancy, cancer, screening, early detection of cancer, treatment, and therapy”. Each result was reviewed to identify primary research articles (excluded case reports and review articles) reporting data about cancer screening and/or treatment for homeless patients. For each included study, information was recorded including publication year, country, study type, patient numbers, and relevance to screening and/or treatment. Results: From this search, 61 publications were identified of which 29 were excluded due to inappropriate scope and/or publication type. In total, 32 publications were included for analysis. Most (81%) reported data from the USA and all were published in 1998 or later. Thirty (94%) reported data about cancer screening in homeless patients. In contrast, only two (6%) reported data about treatment and outcomes. Combined, these studies report screening data from over 8,000 patients compared to treatment data from less than 100. Only one publication reported utilization rates of different treatment modalities. Conclusions: This analysis highlights a disparity in published data about cancer screening and treatment for homeless patients. Little data exists regarding treatment and outcomes of homeless patients following a cancer diagnosis, with even less data about modalities, side effects, and follow-up. Future studies on treatment and outcomes of homeless cancer patients will identify barriers unique to this population and contribute to more evidence-based practices.
Race as an independent factor for survival in breast cancer patients according to analysis of the National Cancer Database (NCDB).
Authors: Murray Drew Carl Drennan , Bhandari Shruti , Ngo Phuong , Mudra Sarah , Lele Rachana Shirish , Srivastava Sudhir , Wu Xiaoyong , Rai Shesh , Mandadi Mounika , Riley Elizabeth Carloss 
Published: May 2019

e18155 Background: Black (B) women after early stage of diagnosis have been shown to have double the risk of white (W) women for failing to receive adjuvant chemotherapy. Despite lower incidence of breast cancer in B patients, they are more likely to die of the disease. Worse outcomes in B populations have been related to clinical and socioeconomic factors. However, the determination of improved access and its effects on survival in black patients remains uncertain. Methods: 1042844 patients diagnosed between 2004 and 2014 with stage I-III breast cancer were identified in the NCDB. Only W and B races were analyzed with established risk factors of age, stage, comorbidity score, and insurance status. Data was analyzed using univariable and multivariable logistic and Cox proportional hazards regression models. Odds Ratio (OR) for binary outcome, Hazard Ratio (HR) for time-to-event (survival) outcome along with 95% confidence interval (95% CI) are reported. Results: Among the total population 85.5% were W, 10.6% B, and 3.9% other. B were more likely to be uninsured (OR: 1.66; 95% CI: 1.59 - 1.72; p < 0.0001), or have Medicaid (OR: 2.01; 95% CI: 1.96 - 2.07; p < 0.0001). B were also diagnosed at later stage (stage 3 OR: 1.59; 95% CI: 1.57 - 1.63; p < 0.0001) with higher co-morbidities (OR: 2.49; 95% CI: 2.34 - 2.67; p < 0.0001) consistent with prior studies. B were more likely to experience delayed treatment (OR: 2.15; 95% CI: 2.10 - 2.20; p < 0.0001). B race remained an independent factor associated with higher likelihood of death compared to W patients (HR: 1.32; 95% CI: 1.3 - 1.34; p < 0.0001) in multivariable analysis. Conclusions: This large database study demonstrates that even when controlling for established risk factors such lack of insurance or Medicaid, higher comorbidities, and later stage at diagnosis, B patients were more likely to experience delays in treatment initiation and worse overall survival. This suggests race remains an independent risk factor for poor outcome even when clinical factors are matched. Further analysis including tumor biology should be examined to better understand this persistent disparity.
Barriers to clinical trial accrual: Clinical trialists' perspectives.
Authors: Kim Edward S. , Kurbegov Dax , Hurley Patricia A. , Waterhouse David Michael 
Published: May 2019

e18156 Background: Oncology clinical trial participation rates remain at historic lows. There are many barriers that impede participation. Understanding those barriers, from the perspective of cancer clinical trialists, will help develop solutions to increase physician and site engagement, with the goal of improving accrual rates and advancing cancer treatment. Methods: Physician investigators and research staff from community-based and academic-based research sites were surveyed during ASCO’s Research Community Forum (RCF) Annual Meeting (N = 159) and through a pre-meeting survey (N = 124) in 2018. Findings and potential solutions were discussed during the meeting. Results: 84% of respondents (n = 84) reported that it took 6-8 months to open a trial and 86% (n = 81) reported that trials had unnecessary delays 70% of the time. The top 10 barriers to accrual identified were: insufficient staffing resources, restrictive eligibility criteria, physician buy-in, site access to trials, burdensome regulatory requirements, difficulty identifying patients, lack of suitable trials, sponsor and contract research organization requirements, patient barriers, and site cost-benefit. Respondents shared strategies to address these barriers. Conclusions: The current state of conducting clinical trials is not sustainable and hinders clinical trial participation. New strategies are needed to ensure patients and practices have access to trials, standardize and streamline processes, reduce inefficiencies, simplify trial activation, reduce regulatory burden, provide sufficient compensation to sites, engage the community and patients, educate the public, and increase collaborations. The ASCO RCF offers resources, available to the public, that offer practical strategies to overcome barriers to clinical trial accrual and has ongoing efforts to facilitate oncology practice participation in clinical trials.
Are racial differences in obesity and insulin resistance related to aggressive breast cancer?
Authors: Gallagher Emily , Leroith Derek , Feldman Sheldon M. , Port Elisa R. , Friedman Neil B , Boolbol Susan K , Killelea Brigid K. , Choi Lydia , Fei Kezhen , Franco Rebeca , Yagnik Radhi , Cruz Daliz , Bickell Nina A. 
Published: May 2019

e18157 Background: Black women are more likely to die of breast cancer and develop more aggressive subtypes than white women. Black women are also more likely to be obese and have insulin resistance than white women. Insulin resistance has been associated with faster tumor growth but has not been studied as a potential mediator of racial disparities in women with breast cancer. We hypothesized that black women would present with more aggressive breast cancer and this would be associated with obesity and insulin resistance. Methods: We recruited 1017 (80% white, 20% black) women with new primary breast cancer, measured fasting blood glucose and insulin, body mass index (BMI), triple negative breast cancer (TNBC) & Nottingham prognostic index (NPI). We classified aggressive breast cancer as NPI > 4.4. We calculated insulin resistance scores (HOMA) and classified insulin resistance as HOMA > 2.8. Patients self-identified race. Results: Of 1017 women, average age was 58 years (SD = 12.0). 373 (37%) were stage 2+ at time of diagnosis; 19% had an NPI > 4.4. Black women presented with higher stage of cancer than white women (stage 2+: 45% vs 35%; p = 0.01), more TNBC than white women (10% vs 5%, p = 0.01), were more insulin resistant (24% vs 11%, p < .0001), had higher BMI (31.4kg/m2 vs 26.6 kg/m2; p < .0001) and NPI > 4.4 (29% vs. 17%, p = 0.0002) than white women. HOMA score was positively but not significantly associated with NPI score (r = 0.05; p = 0.1). Multivariate mediation regression model suggested that HOMA_IR does not mediate the effect from black race to higher NPI score (β = 0.01; 95%CI: -0.017 to 0.039). Conclusions: In women with newly diagnosed breast cancer, black women are more likely to be obese, have higher HOMA & NPI scores than white women. While these data are consistent with the hypothesized relationship of hyperinsulinemia promoting more aggressive breast cancer, to date, insulin resistance does not appear to mediate the effect of race and poor prognostic breast cancer.
The impact of ACA on medical financial hardship among cancer survivors.
Authors: Winn Aaron N , Knueppel Parker , Neuner Joan Marie 
Published: May 2019

e18160 Background: Prior research has documented that privately insured cancer patients are exposed to significant financial burdens which can result in bankruptcy. A key provision of the Affordable Care Act (ACA) was to set limits on patients out-of-pocket (OOP) spending, which was implemented in 2014. This study aims to assess if OOP limits reduces financial hardship. Methods: Using the 2000-2017 National Health Interview Survey we identified cancer survivors under age 65. We performed a difference in difference analysis which compared financial hardship for low- or moderate-income individuals (LMII), family income under $50,000, to those with higher incomes before and after OOP limits were implemented for privately insured patients. Financial hardship was measured in the following ways: delayed medical care due to cost and the number of family members delayed medical care due to costs, could not afford a prescription, medical care or seeing a specialist, and problems paying medical bills. We used multivariate regression models adjusting for age, race, marital status, gender and size of family. All analyses accounted for the complex survey design and weights. Results: We identified 20,879 privately insured, cancer survivors age 65 or younger. The impact of the ACA resulted in lower financial hardships for LMII compared to higher income persons for most outcomes. The impact of the OOP limits on financial hardship for LMII was seen in any family member delaying care due to costs (difference-in-difference (DiD) = -3.6%; 95% CI = -5.9%, -1.5%; p-value = 0.002), number of family members delaying care due to costs (DiD = -0.048; 95% CI = -0.082, -0.135; p-value = 0.002), had problems paying medical bills (DiD = -3.3%; 95% CI = -6.3%, -0.4%; p-value = 0.028), could not afford prescription medication (DiD = -2.3%; 95% CI = -4.2%, -0.3%; p-value = 0.023), could not afford medical care (DiD = -1.9%; 95% CI = -3.5%, -0.3%; p-value = 0.021), but there was no statistically significant difference in the ability to afford seeing a specialist (DiD = -1.1%; 95% CI = -2.6%, -0.5%; p-value = 0.002). Conclusions: Little research has examined the impact of the ACA’s OOP spending limits. In this study we find that after the introduction of OOP spending limits, financial hardship measured in a variety of ways significantly decreased for LMII.
Building international partnerships to improve global oncological care: Perspective from Rutgers-CINJ Global Oncology Fellowship Program.
Authors: Chandar Ashwin , Kaur Sukhdeep , Toppmeyer Deborah , Ralefala Tlotlo Bathethi , Strair Roger , Philipp Claire , Marlink Richard , Antony Reena , DiGiacobbe Marilyn , Lebelonyane Refeletswe , Gaolathe Tendani , Mayer Tina M. 
Published: May 2019

e18161 Background: With cancer accounting for 1 in every 7 deaths worldwide and 60-70% of cancer deaths occurring in low- and middle-income countries, any advancement in cancer care should include understanding to alleviate structural inequalities that produce these global oncologic disparities. Rutgers-Cancer Institute of New Jersey (R-CINJ) Oncology Fellowship program, through partnerships with Rutgers Global Health and University of Botswana (UB), established a global oncology program in 2018 to provide young oncologists in training with this educational opportunity. Aims included understanding challenges faced by cancer patients in Botswana, evaluating opportunities to improve oncology care at Princess Marina Hospital (PMH), scholarly collaborations, and exchange knowledge. Methods: In partnership with PMH, UB, and Ministry of Health and Wellness (MOHW), R-CINJ created a global oncology program consisting of a 1 month rotation at PMH in Gaborone, Botswana, as well as longitudinal research/quality improvement (QI) projects. Two 3rd year oncology fellows rotated with house officers and oncologist at PMH. Weekly video conferences facilitated communication during the elective. Projects continued throughout 3rd year of fellowship, in conjunction with programmatic meetings. Results: Fellows gained exposure to cancer care using limited resources. In working with PMH staff, mentorship was provided, QI ideas were shared, and organizational changes were implemented. Scholarly activity was undertaken to examine trends in chemotherapy utilization at PMH over a 12-month period to assess patterns of malignancy and issues with stock outs. Relationship between pathology at PMH, UB, R-CINJ, and Rutgers Biomedical Engineering was established to expand digital pathology services in Botswana. Conclusions: Our global oncology program is a successful start to an ongoing partnership to help improve cancer care in Botswana. Future directions include development of cancer guidelines and protocols in Botswana, helping limit medication shortages, and establishing telemedicine based collaboration to assist with diagnosis and improve pathology turnaround time.
Influence of timing of goals of care discussion on hospitalization outcomes in metastatic cancer patients.
Authors: Emiloju Oluwadunni , Djibo Djeneba Audrey , Ford Jean G 
Published: May 2019

e18183 Background: Cancer patients often require acute hospitalizations, many of which are unplanned. These hospitalizations have been shown to increase in frequency near the end of life. The American College of Physicians recommends that goals of care (GOC) discussions be initiated early for metastatic cancers. We hypothesize that discussing GOC during hospitalization will help reduce readmissions and improve patient satisfaction, by helping to ensure that patients receive goal-congruent care. We aim to examine the association between the timing of GOC discussion and the patient's length of stay and the time to hospital readmission. Methods: We conducted a retrospective review of medical records of patients with stage IV solid tumors who were hospitalized acutely between August 2017 and July 2018 (N = 241). We assessed demographics, clinical information, timing of GOC discussion, use of palliative care services and hospital readmissions within 90 days. Chi-square tests were used to identify independent associations with having a GOC discussion; and anova was used for continuous variables. We used logistic regression to examine the association with a hospital readmission within 90 days, controlling for potential confounders. Results: The subjects were 26-92 years old and 40.6% were female. Only 43% (n = 106) of patients had a GOC discussion. Age, gender, tumor site, and presenting complaint were not independently associated with having a GOC discussion (p > 0.05). Overall, 34.4% (n = 83) had a palliative care encounter. Having a palliative care consult and being admitted to critical care were independently associated with having a GOC discussion. Early timing of GOC discussion was inversely associated with admission to critical care units (p < 0.05). Length of stay was positively correlated with having a GOC discussion. Thirty-seven percent (n = 91) had unplanned hospital readmission within 90 days. Having any GOC discussion reduced the odds of an unplanned hospital readmission within 90 days by 75% [OR = 0.25, 95% confidence interval (CI) 0.14-0.45]. Conclusions: Among hospitalized patients with stage IV cancer, performing an early GOC discussion is associated with better hospitalization outcomes. It is therefore important to perform GOC discussion early when such patients are acutely hospitalized.
Inpatient outcome of solid tumor associated tumor lysis syndrome.
Authors: Gong Zimu , Ali Faisal , Wang Yanting , Syed Sabah , Garcia Jessica Lee 
Published: May 2019

e18185 Background: Tumor lysis syndrome (TLS) is a constellation of metabolic disturbances that can occur in virtually any malignancy, though it is more common in hematological malignancies given their high tumor burden and growth index. While TLS can occur in patients with solid tumors, the clinical behavior and outcome of solid tumor associated-TLS (STA-TLS) is not well characterized. Methods: We used the national inpatient sample to identify patients with STA-TLS (utilizing the ICD10 code E883; and ICD9 code 27788), from year 2010 through year 2016. Patients with both hematological malignancy and solid tumor, and patients without a cancer diagnosis were excluded. Results: A total of 11,733 patients were identified using the above criteria, of which 2117 (18.0%) had STA-TLS. The median age at admission was 63 years and 940 (44.4%) STA-TLS patients were females. The most common primary cancer sites were lung (26.8%), breast (4.2%), and colon (3.7%). Patients with STA-TLS were more likely to receive mechanical ventilation and less likely to receive red blood cell or platelet transfusion compared to those with hematological malignancies ( Table). STA-TLS was also associated with a significantly higher inpatient mortality rate and shorter length of stay than TLS in hematological malignancies ( P < 0.001). No statistically significant difference was found in the requirement of dialysis, transfusion of plasma, and cardiac arrest rates. Conclusions: STA-TLS is rare with an inferior outcome than TLS in hematological malignancies evident by a higher mechanical ventilation and mortality rate. Future studies should identify factors that impact management and outcome of STA-TLS. [Table: see text]
Vitamin D status and survival in patients with triple negative breast cancer.
Authors: Khoury John , Jinna Sruthi , Sahlieh Ali , Chacko Rebecca , Macari David , Jaiyesimi Ishmael A. , Huben Marianne T. 
Published: May 2019

e18210 Background: Although many studies have investigated the association of blood 25OH-vitamin D (vit-D) levels with breast cancer prognosis, the results have been mixed. It has been suggested that low vit-D concentrations were associated with advanced tumor stage and triple-negative (TNBC) subtype. We retrospectively investigated associations of serum vit-D levels with triple negative breast cancer outcome. Methods: Out of 797 cases of TNBC diagnosed at William Beaumont Hospital between 2006-2017, 163 patients had vit-D level available within 1 year prior to diagnosis. Analyses of vit-D levels was classified by 3 cut points (deficient, < 20.0 ng/mL; insufficient, 20.0-29.9 ng/mL; sufficient, ≥30.0 ng/mL). Primary outcomes are disease free survival (DFS) and overall survival (OS). SPSS statistics 25 software was used to analyze the data. Results: Median age of diagnosis of TNBC was 60. Of these patients 43.6% were diagnosed with stage I, 37.4% at stage II, 4.9% at stage III and 4.9% at stage IV. 47.2% of the patients had sufficient vit-D level prior to diagnosis, 28.2% with insufficient vit-D level and 24.5% with deficient vit-D. Vit-D deficiency was more prevalent in premenopausal than in postmenopausal women (33.3%, 41% and 25.6% in premenopausal women for deficient, insufficient and sufficient levels respectively vs 21.8%, 24.2% and 54% in postmenopausal women). Rates of Vit-D deficiency were not different between early disease and advanced disease (24.3% of patient with stage I-II vs 25% in patients with stage III-IV). Median OS and disease-free survival were not statistically different among the 3 different categories. 5-year OS was 91%, 91% and 85% for deficient, insufficient and sufficient levels respectively. 5-year DFS was 93%, 95% and 95% for deficient, insufficient and sufficient levels respectively. Multivariate COX regression analysis demonstrated that age and stage were associated with mortality, whereas vit-D level was not. Conclusions: The results from this study show that adequate vit-D level do not have an impact on OS and DFS in patients with triple negative breast cancer. Premenopausal women are more likely to have inadequate vit-D level. Identification and treatment of vitamin D deficiency is still important for musculoskeletal health and possibly extraskeletal health in general population and breast cancer survivors specifically.
Socioeconomic contributions to clinical outcome by HPV status in squamous cell carcinomas of the head and neck (SCCHN): An analysis of NCDB.
Authors: Marks Jennifer Aline , Switchenko Jeffrey M. , Steuer Conor Ernst , Herrin Sara , Ryan Martha A. , Patel Mihir , El-Deiry Mark , Beitler Jonathan Jay , Shin Dong Moon , Gillespie Theresa Wicklin , Saba Nabil F. 
Published: May 2019

e18214 Background: HPV association remains one of the most important predictors of clinical outcome in SCCHN. We aimed to determine whether the relationship between HPV status and overall survival (OS) varied by certain socioeconomic factors. Methods: Data were obtained from the National Cancer Database (NCDB). We examined the relationship between OS and HPV status, controlling for demographics and socioeconomic variables (insurance, income, education, urban/rural, great circle distance, and/or distance to treatment facility of 0-10, 10-50, and > 50 miles). Results: HPV status modified the relationship between insurance status (p = 0.011), urban/rural residence (p = 0.041), and overall survival, controlling for age, race, sex, and clinical stage. Whereas for HPV- patients, government insurance conferred a lower risk of death compared to no insurance (HR: 0.86, 95% CI: 0.75-0.99, p = 0.038); this finding did not hold for patients with HPV related disease (HR: 0.97, 95% CI: 0.80-1.18, p = 0.781). For patients with HPV related SCCHN, those living in rural areas have significantly higher risk of death compared to those living in metro areas (HR: 1.55, 95% CI: 1.17-2.05, p = 0.002), which did not hold for patients with HPV unrelated SCCHN (HR: 0.94, 95% CI: 0.68-1.30, p = 0.703). Conclusions: Despite HPV’s prospective prognostication, patients with HPV + SCCHN who live in rural environments have a higher risk of death likely from lack of physical access to care. This finding did not hold for HPV negative population, presumably because of their worse outcomes at baseline, and their struggle for access to care regardless of physical location.