bluuebunny/crossref_metadata_2025_split huggingface dataset:
Audit study of cancer research mentorship opportunities by NCI-funded PIs: Analysis of a pathway barrier for diversity.
Authors: Robinson Jeffrey D. , Dieckmann Nathan , Withers Elizabeth , Hassouneh Dena , Thomas Charles R. 
Published: September 2018

6566 Background: The pipeline of diverse cancer researchers is critical. Audit studies suggest that racial discrimination disadvantages black (vs. white) people with respect to educational/professional advancement (Milkman, 2012). We hypothesized that prospective Black (B) male doctoral students would experience greater disparity in responses when seeking access to NCI-funded PIs compared to prospective Caucasian (W) males. Primary aim: To explore response and acceptance rates for B (vs. W) men seeking cancer-research mentorship. We also explore similar differences when considering evaluators’ race and sex. Methods: Between 9-9:30 am (local time) during a Monday in Oct 2015, identical emails were sent to 1028 randomly selected PIs affiliated with 65 NCI-designated cancer centers. PIs were randomly assigned to receive emails from either ‘Brad Anderson’ (W; n = 513) or ‘Lamar Washington’ (B; n = 515). Primary outcomes: (1) any response within one week (yes/no); and (2) type of response if received (agree to meet/not agree to meet). Logistic regression was used to examine unadjusted and adjusted effects of condition (W/B) on the primary outcomes. In adjusted models, PI sex and time zone were included as covariates (PIs identified as African American = 1.2%). Results: Approximately 50.0% and 48.3% of the sample responded to ‘Brad’ and ‘Lamar,’ respectively. Condition was not a significant predictor of ‘any response’ in either unadjusted (p = .62, odds ratio 95% CI = 0.83-1.35) or adjusted (p = .62, odds ratio 95% CI = 0.83-1.36) models. In the adjusted model, neither PI sex nor time zone were significant predictors of ‘any response.’ For those who responded, 43.7% and 40.9% ‘agreed’ to meet with Brad and Lamar, respectively. Condition was not a significant predictor of ‘response type’ in either unadjusted (p = .53, odds ratio 95% CI = 0.78-1.61) or adjusted (p = .51, odds ratio 95% CI = 0.78-1.64) models. In the adjusted model, only PI sex was a significant predictor of ‘response type’ (p = .03, odds ratio 95% CI = 1.04-2.29), with males (45.8%) being more likely to ‘agree to meet' than female PIs (35.6%). Conclusions: We did not find strong evidence of bias by NCI-funded PIs against B (vs. W) prospective Ph.D. students.
Associations between cancer patients' advance care and financial planning and surviving spouses' financial well-being.
Authors: Wright Alexi A. , Keating Nancy Lynn , Nicholas Lauren Hersch 
Published: September 2018

6567 Background: The “financial toxicity” associated with cancer treatment, including high out-of-pocket expenses and lost earnings, may have lasting financial effects for surviving spouses. Although advance care planning (ACP) is used as a cancer quality metric, the value of financial planning is unknown. Methods: We examined associations between cancer patients’ written ACP and financial planning (will) and surviving spouses’ financial well-being using prospective, nationally representative data from the 2004-2014 waves of the Health and Retirement Study. We assessed change in household, non-housing (financial) wealth, including debt, among 962 surviving spouses of cancer decedents. Because wealth varies widely in the US, we fit multivariable quantile regression models at the 25th, 50th, and 75th percentiles to examine associations between cancer decedents’ ACP, financial planning, and wealth, adjusting for sociodemographic characteristics. Results: Among cancer decedents, 33% completed both ACP and a will, 27% only a will, 10% only ACP, and 30% neither. The median wealth of surviving spouses was $22,309 (25th percentile = $0, 75th percentile = $134,238). Among spouses of cancer decedents in the 25th percentile of wealth before death, completion of ACP and a will was associated with $5,348 (95% CI = $1,172-$9,523) more financial wealth after death compared with no planning. Use of ACP and a will was also associated with $46,851 (95% CI = $2,810-$90,891) more financial wealth at the 75th percentile. There were no differences in the wealth of surviving spouses after death between patients who completed only a will, only ACP, or no planning (Ps > .09). Conclusions: Completion of ACP and financial planning was associated with greater wealth among both affluent and non-affluent surviving spouses compared with no planning. Efforts to sensitively incorporate financial planning into cancer patients’ care have the potential to improve surviving family members’ financial well-being.
Universal testing for hormonal status in breast cancer: Are we choosing wisely?
Authors: Goller Taylor Maxwell , De Luca-Johnson Javier , Rehman Hibba tul , Ambaye Abiy Berhie 
Published: September 2018

6583 Background: Characterizing estrogen receptor (ER) and progesterone receptor (PR) status has long been standard practice with newly diagnosed breast cancers. ER and PR expression suggests a more favorable prognosis and predicts tumor responsiveness to hormonal therapy. However, this testing comes with considerable cost. At our institution, the Medicare reimbursement rate for a single ER/PR assay is $310. With over 300,000 newly diagnosed breast cancers in the US each year, the total cost of ER/PR testing is close to 100 million dollars. Furthermore, the 2010 American Society of Clinical Oncology (ASCO) and the College of American Pathologists (CAP) guidelines suggest that up to 20% of ER/PR testing worldwide may be inaccurate with potential for false negative results. A falsely negative result could lead clinicians to not offer treatment with hormonal therapies. The purpose of this study was to investigate whether nuclear grade could be used to predict ER status, thus saving cost and reducing the potential for false negative test results and the inappropriate withholding of beneficial treatment. Methods: A retrospective analysis of prospectively collected data from the University of Vermont Breast Cancer Database identified all newly diagnosed breast cancers of any histologic type with available data on nuclear grade and ER status (2/2008-10/2016). The relationship between nuclear grade and ER status was analyzed (Table). Results: Nuclear grades 1 and 2 were associated with a significantly higher proportion of ER positive results than high nuclear grades (chi-square test p <.001). Conclusions: Nuclear grade 1 and 2 breast cancers are nearly universally ER positive (99% and 97%, respectively). Thus, ER testing may be redundant in these tumors. Elimination of ER testing in nuclear grade 1 and 2 tumors could save tens of millions of dollars each year in the US alone. It could also reduce the potential for false negative test results and the inappropriate withholding of beneficial treatment. [Table: see text]
Phone call for chemotherapy validation in outpatient unit as a way to optimize health care without compromising patients' satisfaction and quality of life.
Authors: Marino Patricia , Touzani Rajae , Palomares Myriam , Cappiello Maria-Antonietta , Bouhnik Anne Deborah , Guelmani Najoua , Provansal Magali , Vittot Martine , Dermeche Slimane , Braham Farida , Launay Simon , Goncalves Anthony , Ries Pauline , Extra Jean-Marc , Gilabert Marine , Moulin Jean Francois , Gravis Gwenaelle 
Published: September 2018

6588 Background: Patients’ satisfaction is known to be closely linked to the time spent with the physician. However, longer waiting times may be a source of dissatisfaction as well as organizational dysfunctions of the outpatient unit. Is a validation of chemotherapy by phone call instead of a medical consultation with a senior physician before chemotherapy (CT) is feasible without compromising patients’ satisfaction and quality of life? Methods: Pts with OMS < 1, able to respond to phone call, < 76 years, receiving day 8 and or d15 of CT were included. We enrolled 343 pts in a before/after study between 2013 and 2016. In the “before” step (control arm), 168 pts had a systematic physician consultation the same day before CT administration. In the intervention arm 175 pts received a phone call by a junior physician the day preceding CT administration. A specific questionnaire for CT -related toxicity of the previous cycle was recorded and CT was validated or not by physician. The day after, pts received prepared CT without appointment with the oncologist and delay in administration for already prepared CT. At the end of CT protocol, socio demographics, patients’ satisfaction (In-PatSat32) and health status (EQ-5D) questionnaires were completed by patients. Results: Questionnaires were completed by 83% and 74% in before and after step respectively, 241 questionnaires were analyzed. Satisfaction with care showed similar In-PatSat32 scores between arms, for satisfaction with: physician, nurse, organization and services. No differences of perceived health status and toxicity were observed between both groups, but patients’ time spent in hospital was lower in the intervention group versus the control group, (p = 0.007). Conclusions: An alternative care pathway implementing phone calls before CT administration if feasible without compromising pts’ satisfaction, quality of life and toxicity. We believe that saving time of pts, physicians and pharmacists is a way to optimize the model of care in outpatient unit, particularly in the immunotherapy area with more pts received intra venous treatment, probably for a long time.
Concordance assessment of a cognitive computing system in Thailand.
Authors: Suwanvecho Suthida , Suwanrusme Harit , Sangtian Montinee , Norden Andrew D , Urman Alexandra , Hicks Annette , Dankwa-Mullan Irene , Rhee Kyu , Kiatikajornthada Narongsak 
Published: September 2018

6589 Background: IBM Watson for Oncology (WFO) was trained by Memorial Sloan Kettering and is a cognitive computing system that uses natural language processing to ingest patient data in structured and unstructured formats. The system provides physicians with treatment options that are derived from established guidelines, the medical literature, and training from patient cases. In this study, we assessed the degree of concordance between treatment recommendations proposed by WFO and oncologists at Bumrungrad International Hospital (BIH). BIH is a 580-bed multispecialty hospital in Bangkok, Thailand. Methods: Data from breast, colorectal, gastric, and lung cancer patients treated at BIH were entered into WFO in 2015 and 2016. Retrospective cases were entered after a treatment plan had been determined, and prospective cases were entered during patients’ treatment planning sessions. WFO recommendations were provided in 3 categories: “Recommended”, “For Consideration”, and “Not Recommended.” Concordance was analyzed by comparing the decisions made by the oncologists to those proposed by WFO. Concordance was achieved when the oncologist’s treatment suggestion was in the “Recommended” or “For Consideration” categories given by WFO. Results: A total of 211 cases were assessed, 92 were retrospective and 119 were prospective. The overall concordance rate was 83%; 89% for colorectal, 91% for lung, 76% for breast, and 78% for gastric cancer. Similar concordance rates were observed when retrospective and prospective cases were analyzed separately. Discordance was attributable in part to local oncologists’ preferences for non-U.S. guidelines for certain cancers, especially gastric cancer. Conclusions: There was a high degree of concordance between WFO treatment options and the decisions made by local oncologists. Similar results were recently reported in a breast cancer concordance study conducted using WFO in India (San Antonio Breast Cancer Symposium 2016, Somashekhar et al). WFO’s capabilities as a cognitive decision support tool can be further improved by incorporating regional guidelines. Future work will analyze reasons for discordance such as cost, insurance requirements, and patient and physician preference.
Estimating the optimal rate of adjuvant chemotherapy utilization in stage III colon cancer.
Authors: Karim Safiya , Brennan Kelly , Peng Yingwei , Mackillop William J. , Booth Christopher M. 
Published: September 2018

6591 Background: Identifying optimal chemotherapy utilization rates can drive improvements in quality of care. We report a benchmarking approach to estimate the optimal rate of adjuvant chemotherapy (ACT) for stage III colon cancer. Methods: The Ontario Cancer Registry was linked to electronic chemotherapy records to identify ACT utilization among a random 25% sample of patients with stage III colon cancer diagnosed during 2002-2008 in Ontario, Canada. We explored whether hospital factors (teaching status, regional cancer centre, medical oncologist on-site) were associated with ACT rates. The benchmark population included hospitals with the highest ACT rates that accounted for 10% of the patient population. Hospital ACT rates were adjusted for case mix in a multi-level model accounting for random variation at the hospital level. A Monte Carlo simulation was used to estimate the proportion of observed ACT rate variation that could be due to chance alone. Results: The study population included 2,801patients with stage III colon cancer; ACT was delivered to 66% (1861/2801) of patients. There was no difference in hospital ACT rate by teaching status (64% academic vs 67% non-academic, p = 0.107), comprehensive cancer centre status (65% cancer centre vs 67% non-cancer centre, p = 0.362), or having medical oncology on site (67% on site vs 66% not on site, p = 0.840). After excluding hospitals that had case volumes less than 10 (N = 150), unadjusted ACT rates varied across hospitals (range 44% to 91%, p = 0.017). The unadjusted benchmark ACT rate was 81% (95%CI 76%-86%); utilization rate in non-benchmark hospitals was 65% (95%CI 63%-66%). When using adjusted ACT rates in a multi-level model significant variation remained across hospitals (p < 0.001). The adjusted benchmark ACT rate was 74% (95%CI 63%-83%); non-benchmark hospital ACT rate was 65% (95%CI 53%-75%). The simulation analysis suggested that the non-random component of ACT rate variation across hospitals was 1.5%. Conclusions: There is significant variation in ACT rates across hospitals in routine practice. The estimated benchmark ACT rate is 74%. However, simulation analyses suggest that most of the variation in ACT utilization across hospitals may be due to chance alone.
Code status transitions from full code to do-not-resuscitate (DNR) among hospitalized patients with advanced cancer.
Authors: Lau-Min Kelsey S. , Nipp Ryan David , D'Arpino Sara , Moran Samantha M.C. , Hochberg Ephraim , Traeger Lara N. , Jackson Vicki , Cashavelly Barbara J. , Martinson Holly S , Ryan David P. , Greer Joseph , Temel Jennifer , El-Jawahri Areej 
Published: September 2018

6592 Background: Code status discussions ensure the delivery of preference-concordant care. However, the processes by which hospitalized patients with advanced cancer change their code status from full code to DNR are unknown. Methods: We conducted a mixed-methods study on a prospective cohort of patients with advanced cancer who were hospitalized from 9/14-10/15. Two physicians used a consensus-driven medical record review to characterize processes leading to code status transitions from full code to DNR. We explored factors associated with these processes using χ2 and Kruskal-Wallis tests. Results: We reviewed 1,047 hospitalizations among 728 patients. Admitting physicians did not address code status in 52.1% of these hospitalizations, leading code status orders to be presumed full. 273 patients (37.5%) transitioned from full code to DNR; 132 (48.4%) of them had erroneous presumed full code status orders on admission. We identified three additional processes leading to transitions from full code to DNR: acute clinical deterioration (15.4%), discontinuation of cancer-directed therapy (17.2%), and hypothetical discussions regarding the futility of CPR (15.4%). Among these processes, code status transitions due to acute clinical deterioration were associated with less patient involvement, shorter time to death, and higher likelihood of inpatient death. Changes due to hypothetical discussions were more likely to involve palliative care. Conclusions: Half of code status transitions among hospitalized patients with advanced cancer were due to erroneous full code orders, underscoring a greater need to discuss patient CPR preferences. Transitions due to acute clinical deterioration were associated with less patient engagement and higher likelihood of inpatient death. [Table: see text]
Cost-effectiveness of front-line trials in metastatic colorectal cancer: Integrating the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) with the costs of drugs.
Authors: Bonetti Andrea , Giuliani Jcopo 
Published: September 2018

6622 Background: In Western Countries, colorectal cancer (CRC) is the second most common cause of death from cancer. In light of the relevant expenses of drugs it might be interesting to make a balance between the cost of the drugs and clinical parameters of interest such as progression free survival (PFS). Methods: Phase III randomized clinical trials (RCTs) that compared at least two front-line chemotherapy regimens for mCRC patients were evaluated. Differences in PFS between the different arms were calculated and compared with the pharmacological costs (at the Pharmacy of our Hospital) needed to get one month of PFS. Subsequently we applied the ESMO-MCBS (a 1 to 5 scale) to the above phase III RCTs. Results: Overall 28 phase III RCTs, including 19 958 patients, were analyzed. The FOLFOX resulted the least expensive (56 € per month of PFS gained) while the addition of irinotecan to FOLFOX (FOLFOXIRI) increased only marginally the costs (90 € per month of PFS gained). Treatments including the monoclonal antibodies showed a cost per month of PFS gained of 2823 € (FOLFIRI with cetuximab in KRAS wild-type patients and liver-only metastases), of € 15 822 (FOLFOX with panitumumab in KRAS wild type) and of 13 383 € (FOLFOX with bevacizumab). According to the ESMO-MCBS the treatments including an EGFR-inhibitor (cetuximab or panitunumab) were associated with a score of 4 while the inclusion of bevacizumab reached a score of 3. The remaining phase III RCTs obtained a low (grade 1-2) score.Dividing the costs per month of PFS gained with the grade of ESMO-MCBS, for each RCTs, we obtained the costs of each point of ESMO-MCBS per month of PFS gained. FOLFOX was confirmed as being the least expensive (18.7 €) while among treatments including a targeted biological agent panitunumab in combination with FOLFOX in K-RAS wild type patients was less expensive (3955 €) than the combinations FOLFOX-bevacizumab (13 383 €) and FOLFIRI-cetuximab in K-RAS wild type patients (21 854.6 €). Conclusions: Our data demonstrate a huge difference in cost per month of PFS gained and per each point of the ESMO-MCBS in modern front line treatments in mCRC.
Frontline hyper-CVAD plus ponatinib for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia: Updated results of a phase II study.
Authors: Short Nicholas James , Kantarjian Hagop M. , Ravandi Farhad , Daver Naval Guastad , Pemmaraju Naveen , Thomas Deborah A. , Yilmaz Musa , Kadia Tapan M. , Sasaki Koji , Garris Rebecca , Garcia-Manero Guillermo , Dinardo Courtney Denton , Konopleva Marina , Estrov Zeev , Jain Nitin , Wierda William G. , Jeanis Vicky , Cortes Jorge E. , O'Brien Susan Mary , Jabbour Elias 
Published: September 2018

7013 Background: The combination of chemotherapy plus a TKI is highly effective in Ph+ ALL. In this phase II study, we evaluated the safety and efficacy of HCVAD in combination with the third-generation pan- BCR-ABL inhibitor, ponatinib. Methods: Patients (pts) with newly diagnosed Ph+ ALL received 8 cycles of HCVAD alternating with high dose MTX/Ara-C every 21 days. Ponatinib was given at 45 mg daily for the first 14 days of cycle 1. Initially ponatinib 45 mg daily was given indefinitely beginning at cycle 2. Due to concern for vascular events, a protocol amendment was made in which, beginning in cycle 2, pts in CR received 30mg daily and pts in CMR received 15mg daily. Rituximab and IT chemotherapy were given with the first 4 courses. After 8 cycles of HCVAD, pts in CR received maintenance with ponatinib, vincristine and prednisone for 2 years followed by indefinite ponatinib. Results: 64 pts have been treated, 10 of whom had received prior treatment with another regimen (8 in CR, 2 not in CR). Median age was 48 years (range, 21-80) and median follow-up was 33 months (range, 2-62). Median cycles received was 6 (range, 2-8). 63 pts (98%) achieved CR after 1 cycle; 1 pt achieved CRp. CCyR was achieved in 98%, MMR in 97% and CMR in 77%. Median time to CMR was 10 weeks (range, 2-96). Median times to platelet and ANC recovery in cycle 1 were 22 and 18 days, respectively, and for subsequent cycles were 22 and 16 days, respectively. Grade ≥3 pancreatitis was observed in 12 pts (19%), thrombotic events in 4 (6%) and MI in 3 (5%). 8 pts have died, with 2 deaths attributed to ponatinib (both from MI). No grade ≥3 vascular events occurred after the protocol amendment. 38 pts continue to receive treatment (7 in consolidation, 14 in maintenance and 17 post-maintenance). 10 pts (16%) underwent allogeneic SCT in CR1. 7 pts have relapsed, 3 of whom were still receiving ponatinib. The 3-year continued remission and OS rates were 79% and 76%, respectively. In a landmark analysis at 4 months, CR duration and OS did not differ significantly in pts with or without allogeneic SCT. Conclusions: HCVAD plus ponatinib is highly effective in pts with newly diagnosed Ph+ ALL, resulting in high rates of CMR and promising long-term survival. Clinical trial information: NCT01424982.