bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modeling accrual of older adults to cancer clinical trials: (Alliance A151736).
Authors: VanderWalde Noam Avraham , Wakefield Daniel Victor , Satele Daniel V. , Dockter Travis , Sloan Jeff A. , Jagsi Reshma , Lichtman Stuart M. , Freedman Rachel A. , Lafky Jacqueline M. , Muss Hyman B. , Cohen Harvey Jay , Hurria Arti , Jatoi Aminah , Le-Rademacher Jennifer 
Published: May 2019

e18132 Background: Older adults (65+ years) make up > 50% of cancer patients in the US,1 yet, older patient enrollment onto trials remains < 30%.2 This study’s aim was to determine the association between trial level variables and accrual rates of adults 65+ to better design trials that can more improve enrollment of these patients. Methods: We analyzed enrollment percentages of patients age 65+ in non-age specific Alliance trials with > 50 patients, that completed accrual between 1995- 2015. Enrollment percentage by 65+ for each study was compared to cancer incidence percentage by 65+ according to the Surveillance, Epidemiology, and End Results (SEER) Program for the same time periods. Enrollment Disparity Difference (EDD)3, defined as the difference between SEER incidence percentage of patients 65+ and the trial percentage enrollment of 65+ was calculated for each trial ( SEER % – trial %). Univariate analyses (UVA) were performed using simple linear regression to determine trial variables associated with larger EDDs (higher disparity). Variables that had an F-test p-value < 0.20 were included in a multivariable fixed-effects linear model for multivariate analysis (MVA). Results: Median age of 66,708 patients across 237 trials with 10 cancer types was 60 years. Average % of 65+ in trials was lower than average SEER comparison % 65+ per trial (37.6% vs. 57.8%). The median trial EDD, was 16.7%. On UVA, cancer type was significantly associated with higher EDD (see Table). Use of fewer modalities (1, 2, vs 3+) was associated with lower estimated EDDs (1 = -11 [+/-3.6], 2 = -8.9 [+/-3.9], F-test p = .012). On MVA, non-genitourinary (GU) cancer type, number of treatment modalities, and the phase (II or III compared to observational/other) were all significantly associated with higher EDD. Conclusions: Older adults were under-represented in this large sample of trials. This information can be used as a platform to better design disease-specific trials to improve older patient accrual, particularly in disease areas which are under-performing. Support: U10CA180821, U10CA180882, UG1CA189823: https://acknowledgments.alliancefound.org . References: 1. Smith BD et al. J Clin Oncol 27:2758-65, 2009; 2. Hurria A, et al. J Geriatr Oncol 1:40-44, 2010; 3. Pang HH, et al. J Clin Oncol, 2016.[Table: see text]
Disparities in survival by insurance status in chronic lymphocytic leukemia.
Authors: Mohammed Kahee A. , Al-Hammadi Noor , Hamieh Lana , Osazuwa-Peters Nosayaba , Hinyard Leslie J. 
Published: May 2019

e18134 Background: Chronic Lymphocytic Leukemia (CLL) is the most common leukemia in western world. It is the disease of older adults with a median age at diagnosis of approximately 70 years. However, significant proportion of younger adults are diagnosed with CLL and they usually have an adverse clinical and molecular risk profile necessitating early interventional strategies compared to older patients. Socioeconomic disparities may affect survival for some patient populations. This study examined survival by insurance status for younger patients with CLL. Methods: The Surveillance, Epidemiology, and End Results database was used to identify patients, aged 15 - 64 years, who were diagnosed with CLL between 2007 and 2014 and whose insurance status (no insurance, Medicaid, and other insurance) was documented at diagnosis. Unadjusted associations between insurance status and overall survival (OS) were plotted using Kaplan-Meier curves. The association between insurance status and CLL-specific mortality was assessed using multivariate Cox proportional hazards regression models, adjusting for sociodemographic covariates. Results: A total of 10,913 patients with CLL were included with a median follow up of 44 months. Five-year survival estimates were 87.3%, 87.2%, and 94.0% for patients with no insurance, Medicaid, and other insurance, respectively. In multivariate analysis, compared to patients with other insurance, patients with no insurance (hazard ratio [HR] = 2.33, 95% confidence interval [CI] = 1.73 – 3.140) and Medicaid (HR = 1.95, 95% CI = 1.49 – 2.54) had significantly worse OS survival after adjusting for sociodemographic factors. Conclusions: Younger patients with no insurance or Medicaid have lower survival outcomes after diagnosis with CLL compared to patients with other insurance. Addressing barriers to care, providing resources, and expanding access to care is paramount to reducing the gap in survival for the uninsured patients and those with lower socioeconomic status. Further studies are needed to address poor survival outcomes among Medicaid patients.
Contributive compared with subsidized insurance in colorectal cancer in the Colombian National Administrative Cancer Registry.
Authors: Hsu Robert , Ramirez Paula , Acuña Lizbeth , Lopes Gilberto 
Published: May 2019

e18136 Background: Colombia has gone to great lengths to provide nearly universal health care insurance for its patients, as 96.6% of its constituents now have health insurance as of 2014 compared to 23.5% in 1993. Most Colombians are associated with either contributive insurance (CI) in which employees and employers contribute to the insurance or subsidized insurance (SI) in which government funds cover the insurance cost. Colorectal cancer (CRC) has the 5th highest incidence of all malignancies in Colombia. This abstract aims to compare CRC care delivery metrics between CI and SI. Methods: We used the Colombian National Administrative Cancer Registry (NACR) data compiled from the Department of Health Ministry from January 2, 2016- January 1, 2017 consisting of 32 departments and 1122 municipalities. CRC cases were investigated by incidence, mortality, percentage of cases with early stage detection, stage I-III with curative surgery intent, nutritional support, and TNM staging, and days between suspicion to diagnosis, diagnosis to first treatment, neoadjuvant therapy to surgery, and surgery to adjuvant therapy. Results: There were 2605 new CRC cases in the NACR in 2017, with 1691 CI cases and 823 SI cases. There was a noticeably higher incidence in CI (7.2 new cases per 100,000 people) than in SI (3.7 new cases per 100,000), and a higher mortality rate (5.0 deaths per 100,000) in CI compared with SI cases (2.6 deaths per 100,000). There was a significant increase in average wait time for SI CRC cases from diagnosis to first treatment (77.7 days vs. 57.3 days, p = .027) and in average time to neoadjuvant therapy to surgery in CI cases (123.1 days vs. 92.5 days, p = .054) with longer but statistically insignificant wait times in SI cases in average time to adjuvant therapy (83.6 days vs. 73.9 days, p = .0168) and suspicion to diagnosis (56.1 days vs. 46.9 days, p = .811). Similar percentages of CI and SI cases had early stage detection (37.2% in SI vs. 34.3% in CI, p = 0.311), TNM staging (50.7% in CI vs. 49.3% in SI, p = 0.146), stage I-III cases with curative surgery intent (23.3% in CI vs. 21.8% in SI, p = 0.833), and nutritional support (10.5% in CI vs. 8.5% in SI, p = 0.942). Conclusions: The NACR represents a model for developing countries to improve cancer care delivery efficiently. As evidenced by higher incidence and mortality in CI cases and longer wait times before treatment in SI cases, there are differences in cancer care delivery between major modes of healthcare delivery in Colombia. More investigation needs to be done with a goal of streamlining cancer care delivery.
Delays in diagnosis in young patients with leukemia and lymphoma.
Authors: Winestone Lena , McPheeters Jeffrey , Puccetti Diane , Wilkes Jennifer Jill , Muffly Lori S. , Kahn Justine , Henk Henry J. , Ginsberg Jill P. , Keegan Theresa , Pollock Brad H. , Alvarez Elysia Marie 
Published: May 2019

e18138 Background: Patients diagnosed with leukemia and lymphoma typically present with nonspecific symptoms, making a timely diagnosis difficult. Little is known about factors associated with delays in diagnosis. We hypothesized that age, minority race/ethnicity, and low income are associated with greater time to diagnosis. Methods: Using the OptumLabs Data Warehouse, which includes claims data for privately insured enrollees in a large US health plan, we identified 17,536 pediatric (0-14 y), adolescent (15-21 y), and young adult (22-39 y) patients diagnosed with acute leukemia or lymphoma between 2001-17. Using this retrospective cohort, potential cancer-related symptoms occurring up to 6 months pre-diagnosis were identified. Delay was defined as > 3 months from symptom onset to diagnosis. Contingency table analysis with chi-squared tests and unconditional logistic regression were used to estimate the association between sociodemographic factors and delays in diagnosis. Results: Seventy-eight percent of patients had a diagnosis of a cancer-related symptom in the 6 months prior to diagnosis. The most common presenting symptoms were lymphadenopathy, fever, and cytopenias. The median days to diagnosis was longer in young adults (93) than children (86) or adolescents (81) (p = < 0.0001). For pediatric v. AYA patients, median days to diagnosis differed for those with constitutional symptoms (18 v. 37, p = < 0.001), infectious symptoms (93 v. 74, p = < 0.001), and cytopenias (11 v. 22, p = < 0.001). Multivariable analysis identified younger age, female sex, and low household income to be significantly associated with delays in diagnosis (table below). Conclusions: In this large cohort of privately insured patients, adolescents had the shortest time to diagnosis. We saw no disparities by race/ethnicity or education but observed that low income ( < $40K) and female patients had greater odds of delays in diagnosis. [Table: see text]
Worse outcomes associated with public insurance at sarcoma diagnosis in adolescent and young adults (AYAs).
Authors: Alvarez Elysia Marie , Maguire Frances , Parsons Helen M. , Morris Cyllene , Parikh-Patel Arti , Malogolowkin Marcio H. , Wun Ted , Keegan Theresa 
Published: May 2019

e18143 Background: Studies have shown that having public or no insurance at sarcoma diagnosis is associated with higher stage disease and poor survival. However, previous studies have not differentiated sarcoma patients who enrolled in Medicaid at diagnosis from those previously insured, groups with differing access to care. Therefore, we examined the impact of insurance on stage at diagnosis and overall survival for AYAs with soft tissue sarcoma (STS), osteosarcoma (OS) and Ewing sarcoma (EWS). Methods: Using Medicaid enrollment data linked to the California Cancer Registry, we identified AYAs with STS (n = 1782), OS (n = 458), and EWS (n = 348), diagnosed during 2005-14. Insurance was classified as Medicaid [1. Continuous (≥5 months prior to diagnosis), 2. Discontinuous, 3. At diagnosis (no coverage prior to diagnosis)], private, and uninsured. Logistic and Cox proportional hazards regression determined the association of insurance with metastatic stage (vs localized) and overall survival, respectively adjusting for sociodemographic factors, baseline comorbidities, type of facility, treatment (survival) and stage (survival). Results: Only 17.5% of sarcoma patients had continuous Medicaid prior to diagnosis, with 11% of STS, 17% of EWS and 19% of OS patients obtaining Medicaid at diagnosis. AYAs with Medicaid at diagnosis [Odds Ratio (OR) 3.03, 95% Confidence Interval (CI) 2.27-4.03; vs private] and discontinuous Medicaid (OR 2.25, CI 1.48-3.41) had a higher likelihood of metastatic disease. STS patients with Medicaid at diagnosis [Hazard Ratio (HR) 1.83, CI 1.44-2.33; vs private) and discontinuous Medicaid (HR 1.45, CI 1.01-2.08) had worse survival. Medicaid at diagnosis (HR 1.68, CI 1.07-2.63) also was associated with worse survival in OS patients, but this association was not observed in EWS patients. Conclusions: Lacking insurance prior to diagnosis is associated with metastatic disease at presentation and worse survival in AYA patients with sarcoma. Health insurance remained associated with worse survival even after adjusting for stage, highlighting the importance of continuous health insurance to improve outcomes for this patient population.
Evaluation of racial disparities in the treatment of United States veterans with pancreatic cancer.
Authors: Thomas Theodore Seth , Luo Suhong , Keller Jesse W. , Sanfilippo Kristen Marie , Carson Kenneth Robert 
Published: May 2019

e18148 Background: Recent studies have demonstrated racial disparities in pancreatic ductal adenocarcinoma (PDAC) treatment. Black patients with PDAC are less likely to undergo surgery or receive systemic therapy compared to white patients. One explanation for this may be access to healthcare. The aim of this study is to evaluate racial disparities in treatment of PDAC patients in a cohort of United States Veterans with equal insurance access. Methods: This study is a multicenter, retrospective cohort study. The VA Central Cancer Registry was used to identify patients diagnosed with PDAC from Oct 1st, 1998-Dec 31st, 2014. This cohort was divided into surgically resected and advanced/unresectable groups. The primary outcome for the surgery cohort is the association between race and receipt of adjuvant therapy. The metastatic cohort includes patients with stage III/IV without surgery record. The primary outcome is the association between race and recorded chemotherapy within 6 months of diagnosis. Primary outcomes were assessed using multivariable logistic regression controlling for age and comorbidities. Associations between race and survival for each sub-cohort were assessed using cox proportional hazards analysis. Results: The surgery cohort consisted of 1,835 patients of whom 356 (19%) were black and 1,433 (78%) were white, with 660 (36%) receiving adjuvant treatment. There was no association between race and receipt of adjuvant treatment (OR 1.00, 95% CI 0.78-1.28). There was no difference in survival up to 3 years in white patients compared to black patients (HR 0.99, 95% CI 0.86-1.14). The metastatic disease cohort consisted of 7,983 patients of whom 1,610 (20%) were black and 6150 (78%) were white, with 2,885 (36%) receiving chemotherapy. There was no association between race and receipt of chemotherapy in patients with advanced disease (OR 1.02, 95% CI 0.91-1.15). There was no difference in survival up to 1 year in white patients compared to black patients (HR 0.96, 95% CI 0.90-1.01). Conclusions: This study failed to demonstrate an association between race and adjuvant therapy or systemic therapy administration. There was no difference in overall survival in this cohort. Previously described racial disparities in the treatment of advanced PDAC do not extend to the equal insurance access VA Health Care System.
Evaluating use of interpreters in educating immigrants on cancer prevention and screening guidelines.
Authors: Bulone Linda , Korc-Grodzicki Beatriz , Gangai Natalie , Manna Ruth , Costas-Muñiz Rosario , Kemeny Margaret 
Published: May 2019

e18149 Background: Community outreach is commonly used to disseminate cancer prevention & screening guidelines (CPSG). Minority, immigrant populations with language barriers tend to be excluded from these activities due to the lack of bilingual professionals available to deliver this education. This program was aimed to test whether CPSG education improves knowledge after being taught by an English-speaking medical professional and nonmedical, community-based interpreters working in South Asian and Hispanic communities in New York City (NYC). Methods: Team members from two cancer centers and community-based minority organizations in NYC partnered to create and deliver programs on CPSG to linguistically diverse communities by an English-speaking medical professional utilizing community-based interpreters. Participant knowledge was assessed using matched pre-post surveys in participants’ respective languages. Behavioral intention was measured using a Likert scale from 1-4 with anchors at 1) “Will not do it” and 4) “Already have/doing it”. Paired t-tests were used to compare pre to post mean score and a p-value < 0.05 was considered statistically significant. Behavioral intention rated positively if participants endorsed “will do it” or “already doing” the healthy behavior. Results: 188 community dwelling adults participated in 5 educational sessions, 122 completing pre and post assessments. Median age was 68, two thirds (69%) were female. 94% were born outside of the US, coming from 12 different countries, speaking 6 different primary languages. Knowledge increased from an average of 33% correct responses pre-session to 63% correct post-session – a statistically significant change ( t (121) = -10.58, p < .001). Behavioral intention scores reveal 83-96% participants reporting they will continue to or plan to seek screening and screening information from their doctors as well as make lifestyle changes related to decreasing their cancer risk. Conclusions: This program demonstrates CPSG can not only be taught in English with use of interpreters, but can be successfully received by immigrant community participants who historically may not have these programs available to them due to language barriers.
Healthcare disparities among cancer patients in the emergency department: How do race and ethnicity affect bounce-back rates?
Authors: Coyne Christopher John , Shatsky Rebecca Arielle , Brennan Jesse , Martinez Elena 
Published: May 2019

e18150 Background: Previous studies have demonstrated that patients with cancer utilize the emergency department (ED) more frequently than the general population. Additionally, cancer patients are more likely to require a repeat ED visit within 7 days of a preceding ED discharge (bounce back). This may be a marker of inadequate care or missed diagnosis. We designed this study to evaluate whether there are differences in bounce-back rates among cancer patients of different races/ethnicities. Methods: We performed a retrospective cohort study to compare all cancer-related ED visits in California based on race/ethnicity using the Office of Statewide Health Planning and Development (OSHPD) database. We queried all cancer-related ED visits in 2016 among patients ≥18 years and recorded general demographics. Our outcome measures were bounce-back rate and admission rate on the second ED visit. All data were analyzed using SPSS software and descriptive statistics are reported. Results: In 2016, there were 73,465 patients with 103,523 cancer-related ED discharges that met study inclusion criteria. 18% (18,491 visits) of these visits resulted in a bounce-back (versus 13.3% in the general ED population). African American patients had the highest bounce-back rate at 19.5%, followed by Hispanics (18.9%), Non-Hispanic Whites (17.3%) and Asians (17%). We observed an inverse trend in admission rates on the bounce-back visit, with Asian patients having the highest admission rate (40.5%), followed by Non-Hispanic Whites (37.7%), Hispanics (35.1%), and African Americans (32.5%). This is in the context of an overall admission rate of 36.7%, and a high mortality rate on the bounce-back visit of 8.4%. All groups were similar with respect to age, gender, and disease burden. Conclusions: Overall, we observed that African Americans and Hispanics returned to the ED at rates above average, which may be a marker of inadequate care or misdiagnosis. Furthermore, these groups were discharged at a higher frequency on the second visit, despite the high mortality associated with a bounce-back visit. Further investigation is needed to identify actionable targets to improve the emergency cancer care of all races/ethnicities.
Are two sites better than one?: Sites of care and quality of myeloma treatment.
Authors: Renteria Anne , Jagannath Sundar , Fei Kezhen , Lin Sylvia , Yagnik Radhi , La Lisa , Lin Jenny J. , Bickell Nina A. 
Published: May 2019

e18159 Background: Care coordination affects the quality of cancer treatment. Multiple Myeloma (MM) patients frequently are cared for by local and referral center physicians. We sought to determine whether getting treated at different sites might impact on the quality of MM care. Methods: We used NCCN 2014 and CMS guidelines to define categories of treatment quality and transplant eligibility. We defined high quality MM care as: Induction for all patients with ECOG < 4; harvest & transplant for patients completing induction without progression, with albumin > 2.8, bilirubin < 3 and age ≤77 years; maintenance for transplant ineligible patients completing induction with no progression & for transplant eligible patients completing transplant with no progression; and supportive care of receiving bone targeting agents, anticoagulation and infection prophylaxis for all patients receiving MM therapy. Patients who received care with both local and referral center physicians were considered to have received care at 2 sites. We abstracted 709 charts of patients with ICD-9 diagnosis of MM from 2010-2014 for demographics, site of care and treatments received. We compared groups with chi square and multivariate logistic regression models with age, insurance, race, comorbidity and sites of care to predict care quality. Results: Of the 709, 388 had active MM. On average, patients were 62 ±11 years. Overall, 70% received care at > 1 site. Referred patients had no differences by age, comorbidity index, insurance or race. Having > 1 care site was associated with higher rates of induction and harvest. Conclusions: Historically, hand-offs in care have been associated with poorer quality. However, in a referral center, hand-offs do not negatively affect induction and harvest care quality. Patients referred to a MM center are more likely to get high quality treatments for which they are referred, but referral does not ensure receiving the full gamut of needed MM treatments.[Table: see text]