bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of race and insurance status on survival of patients with non-small cell lung cancer.
Authors: Minocha Vinay Nikhil , Smotherman Carmen , Hew Jason Desmond , Pham Dat C. 
Published: September 2018

e18064 Background: Previous studies have demonstrated disparities in survival outcomes between black and white patients with lung cancer. Black patients are more likely than white patients to have no health insurance or insufficient coverage which may limit their access to treatment. The purpose of this study was to determine the impact of race and insurance status of patients with non-small cell lung cancer on survival outcomes at our institution. Methods: Our study included patients diagnosed and treated for non-small cell lung cancer from 2005 through 2015 at University of Florida hospital in Jacksonville. Cox proportional hazard models were used to study the effect of race (black vs white), insurance, age, tobacco use, family history of cancer and stage on hazard rates for mortality. Time to treatment was compared between blacks and whites using the non-parametric Wilcoxon rank sum test. Results: Of the 1301 patients in our study, 445 (34%) were black. More black patients had Medicaid (24% vs 18%, p = 0.01), and were diagnosed at stage III or IV (81% vs 75%, p = 0.01) compared to white patients. Black patients had higher death rates compared to white patients (80% vs. 71%, p < .0004). Adjusting for stage and insurance, black patients had higher hazard rates for mortality than white patients (HR = 1.18, 95%CI 1.03, 1.35, p = 0.02). Patients with Medicaid and Medicare without supplement had higher hazard rates for mortality compared to other insurance categories (Table). There was no significant difference in time to treatment amongst patients of different races (p = 0.38) and insurance types (p = 0.54). Conclusions: Our study reveals worse survival outcomes in black patients compared to white patients with non-small cell lung cancer, controlling for insurance status and stage at presentation. Future research is needed to determine whether other factors may explain these racial disparities. [Table: see text]
Analysis of potential disparities by race, ethnicity, and age in adult accruals to NCI National Clinical Trials Network (NCTN) breast, lung, prostate, and colorectal trials.
Authors: Mishkin Grace , Temkin Sarah Madhu , Denicoff Andrea , Kohn Elise C. , Massett Holly A. , Mooney Margaret M. , Abrams Jeffrey S. , Minasian Lori M. 
Published: September 2018

e18072 Background: Previous studies have raised concerns about disparities in patient accrual to NCI cancer trials and how this could impact the generalizability of trial results. This study compared the demographics of patients enrolled in NCTN cancer trials to the incident US population. Methods: We analyzed US adult accruals aged 40 or older to NCTN breast, lung, prostate, and colorectal cancer treatment trials between the launch of the NCTN on 3/1/14 and 12/31/16. Accruals were compared to the proportion of patients with these cancers by race, ethnicity, and age in the US population estimated using census-adjusted SEER incidence data for 2010-2013. Results: There were 14,247 accruals across 56 NCTN group treatment trials in breast (39.7% of accruals), prostate (25.9%), lung (23.9%), and colorectal cancers (10.5%). Hispanic and black patients were underrepresented in prostate, lung, and colorectal trials, but overrepresented in breast trials (see table). American Indian/Alaska Native populations were slightly overrepresented in 3 of 4 disease areas, and Asian populations in 2 of 4. Elderly patients were underrepresented in breast, lung, and colorectal cancers, with the greatest disparities in colorectal cancer patients over age 70 (19% of accruals versus 48% of incident patients). However, prostate cancer patients aged 65 to 84 were overrepresented (46% versus 36%). Conclusions: Disparities in race and ethnicity between patients accrued to NCTN studies and the incident population were smaller than seen in previous studies. However, challenges remain in certain diseases, and particularly in enrollment of elderly patients. Improvement efforts should focus on key disparities. [Table: see text]
Racial/ethnic differences in comprehension of biospecimen sharing/banking: University of Rochester Cancer Center NCI Community Oncology Research Program (URCC-NCORP) nationwide study in 710 cancer and healthy subjects.
Authors: Asare Matthew , Kamen Charles Stewart , Morrow Gary R. , Heckler Charles E. , Peppone Luke Joseph , Long Joan , Cole Sharon , Onitilo Adedayo A. , Feige Michelle M , Minasian Lori M. , Windler Dave , Weil Carol J. , Janelsins Michelle Christine 
Published: September 2018

e18077 Background: Informed consent documents containing language about biospecimen storage/sharing (BSS) may be a barrier to minority participation in cancer research. We explored this issue in a nationwide URCC-NCORP observational study by assessing whether breast cancer patients and healthy control subjects, who provided consent to a cognitive function study, differed in their understanding of the ways their BSS could be used by researchers. Methods: We analyzed cross-sectional data from female breast cancer patients scheduled to receive chemotherapy at NCORPs and healthy controls. After reading a consent form related to BSS and consenting to participate in a study about cognitive function, participants’ understanding of BSS was evaluated using four items for biospecimen sharing (score 0-4); three items for relevance to care (score 0-3); nine items for biospecimen use (score 0-9); and six for research purpose (score 0-6); a higher score indicates better understanding. Linear models were used to compare the mean scores between white and non-white subjects, adjusting for education and baseline reading comprehension (WRAT). Results: 461Breast cancer patients and 249 healthy controls completed the survey. The adjusted linear models showed that white subjects scored higher than non-whites (mean scores 14.43 vs. 13.43) on the survey questions overall (p < 0.05), after accounting for education and WRAT. White subjects were more likely than non-whites to correctly answer all the questions for the biospecimen use (42.1% vs. 34.4%, p < 0.22), biospecimen sharing (31.3% vs. 28.1%, p < 0.74), relevance to care (35.1% vs. 17.2%, p < 0.01), and research purpose (4.1% vs. 1.4%, p < 0.97). Conclusions: Our research suggests that informed consent comprehension related to BSS is low overall across all racial/ethnic backgrounds, but non-white subjects’ scores remained lower than whites even after adjusting for education and WRAT. Efforts should be made by researchers to make it easier for all study subjects, especially non-white subjects, to understand informed consent form and BSS.
Are NCI-designated cancer centers websites linguistically accessible?
Authors: Rodriguez Jorge Alberto , Davis Roger B , Nipp Ryan David , Moy Beverly , Percac-Lima Sanja 
Published: September 2018

e18078 Background: The digital divide has shifted from disparities in internet access to disparities in content and design. Technology overlooks limited English proficient (LEP) patients, resulting in a lack of translated online content, possibly increasing disparities in cancer prevention, treatment and clinical trial participation. We sought to determine the language accessibility for the websites of the NCI-Designated CC. Methods: In January 2017, we performed a cross-sectional review of the language accessibility of NCI-Designated CC homepages using manual review and informatics methods (i.e., web scraping). Web scraping automates data extraction from online content. The primary outcomes were presence of translated content, number of languages available and method of translation defined as no translation, Google Translate (GT) or manual translation. Manual translation was categorized as limited (few phrases), moderate (1 webpage) or full ( > 1 webpage or entire site). We used logistic regression to assess the relationship between translated website content and CC county demographics: percent LEP, median income and percent of households with an internet subscription. We performed Spearman Rank Correlation by ranking translation effort: no translation, GT, limited, moderate and full translation. Results: Of 69 NCI-Designated CC websites, 54 (78.3%) were without translation, 12 (17.4%) were manually translated and 3 (4.3%) used GT. Of 12 manually translated websites, 6 had fully, 4 had moderate and 2 had limited translations. Of 16 languages offered, Spanish was the most common (100%), followed by Chinese (50%) and Arabic (33%). We found no significant increase in the odds of having a translated website as related to LEP population, median income or percent of households with internet subscription by CC county. There was no correlation between the translation effort and LEP population, internet subscription or median income by CC county. Conclusions: We found that most NCI-Designated CC offered no translations of their website content. Despite cancer health disparities and the increasing role of health technology, the NCI-Designated CC websites currently remain inaccessible to LEP patients.
Delivering global cancer care: An international study of medical oncology workload.
Authors: Fundytus Adam Michael , Sullivan Richard , Vanderpuye Verna D. , Seruga Bostjan , Lopes Gilberto , Hammad Nazik , Sengar Manju , Hopman Wilma M , Brundage Michael Donald , Booth Christopher M. 
Published: September 2018

e18080 Background: With a disproportionate global burden of cancer, access to care in low-middle income countries (LMICs) is a pressing issue. To our knowledge there is no literature that has described medical oncology (MO) workload in the global context. Here, we report the first results of an international study of global MO training, infrastructure and workload. Methods: A multinational panel of oncologists from diverse practice settings designed a 51 item online survey. The survey was distributed through a snowball method via national oncology societies to chemotherapy-prescribing physicians in 50 countries. Countries were classified into low or low-middle (LMIC), upper-middle (UMIC) and high-income countries (HIC) based on World Bank criteria. Due to small numbers, African nations were reported as a region. The primary objective of this study was to describe the annual number of new cancer patient consults seen per oncologist. Results: 708 physicians completed the survey; 14% (96/708) from LMICs, 21% (152/708) UMICs, and 65% (460/708) HICs. 85% (604/708) of respondents were MOs, 9% (65/708) clinical oncologists, 6% (39/708) other. Respondents worked a median 5 days/week and had 4 weeks of annual paid vacation. The median number of annual consults per oncologist was 175 (IQR 125-375); 16% (114/708) of respondents saw 500+ new patients in a year. Annual case volume in LMICs (median consults 425, 46% respondents seeing > 500 consults) was substantially higher than UMICs (175, 15% > 500) and HICs (175, 10% > 500) (p < 0.001). Among LMICs, UMICs, and HICs, median days worked per week were 6, 5, 5 respectively (p < 0.001); annual weeks of paid vacation were 3, 3, 5 respectively (p < 0.001). Among countries/regions with 10+ responses, the highest annual case volumes per oncologist were Pakistan (median consults 950, 73% > 500 consults), India (475, 47% > 500), Turkey (475, 25% > 500), Africa (400, 42% > 500) and China (325, 31% > 500). Conclusions: There is substantial global variation in oncology case volumes and clinical workload; this is most striking among LMICs. Further work is needed to quantify activity-based global MO practice and workload to inform training needs and the design of new pathways and models of care.
In-hospital outcomes of acute myeloid leukemia (AML) patients undergoing allogeneic hematopoietic stem cell transplant (HCT).
Authors: Durani Urshila , Hogan William J. , Litzow Mark Robert , Alkhateeb Hassan , Kansagra Ankit J. , Go Ronald S. 
Published: September 2018

e18091 Background: Allogeneic HCT is a potentially curative option for certain patients with AML. However, in-hospital outcomes and cost haven't been described. We use the NIS, a nationally weighted sample of hospital discharges in the US, to examine these outcomes. Methods: Years 2002-2013 of the NIS were queried for adults with a primary diagnosis of AML undergoing HCT. Mortality, length of stay, hospital charges, and complications were analyzed and predictors of increased charges and mortality were determined with multivariate regression analysis. Results: From 2002-2013 19,965 adults with AML were admitted for HCT. Donor sources included peripheral blood stem cells (PBSCTs) (79%); bone marrow (BMTs) (15%); umbilical cord blood (6%). In hospital mortality was 8%. Major complications included stomatitis (36%), total parenteral nutrition (TPN) (17%), neutropenic fever (14%), bacteremia (12%), mechanical ventilation (6%), and dialysis (3%). Median charges per hospitalization increased (p<0.01) from $161,894 (2002) to $324,765 (2013); median length of stay (27 days) remained stable over time. Multivariable regressions are depicted (Table). Umbilical cord blood transplants were associated with increased mortality (OR 2.25, p<0.01) and charges ($69,105, p<0.01) relative to PBSCTs. Conclusions: This study demonstrates increasing cost of BMT on a national level as well as increased cost and mortality with umbilical cord transplants. [Table: see text]
Modifiable risk behaviors in adolescents and young adults (AYA) with cancer.
Authors: Smith Lia J. , King Andrea C. , Lin Xiaolei , Hedeker Donald , Henderson Tara O. 
Published: September 2018

e18095 Background: A cancer diagnosis in adolescents and young adults (AYA) comes at a complex developmental interval that often coincides with risky behaviors, such as substance use. Modifiable risk behaviors are an important area of research to minimize morbidity for AYA. Our goal was to examine substance use, affect, and other health indicators in a diverse AYA cancer patient sample. Methods: We identified patients between the ages of 18-39 years and 6 or more months from date of cancer diagnosis. Measures included demographic, general health and substance use variables, the Center for Epidemiologic Studies Depression Scale (CES-D), and the State-Trait Anxiety Inventory (STAI-T). Linear trend analyses were performed to examine group differences. Backward-selection ordinal regression analyses identified specific factors associated with risky health behaviors. Results: Participants (60% male; Mage = 27; 70% White; 14% Black) included 100 patients with primary diagnoses of lymphoma (N = 45); leukemia (N = 37); sarcoma (N = 10); other (N = 8). Median time from cancer diagnosis was 2 years (range 6 months - 20 years). Past year alcohol, cigarette, and marijuana use was reported in 80% ,15%, and 33% of participants, respectively. We classified three subgroups based on past year alcohol and smoking, including non-smoker/non-drinker (n = 20), non-smoker/drinker (n = 65), and smoker/drinker (n = 15). Linear trend analyses indicated that the groups did not differ on time since diagnosis, but the smoker/drinker group initiated drinking younger ( p< 0.01), were more likely to use marijuana in the past year ( p< 0.01), and had increased depressive symptoms (CES-D; p< 0.01), anxiety (STAI-T; p< 0.05), body pain ( p< 0.05), and poorer sleep quality ( p< 0.05). Backward model selection treating outcome categories as ordinal indicated that frequent marijuana use and poor sleep quality were associated with being a past year smoker/drinker. Conclusions: A sizeable portion of AYA cancer patients engage in drinking and smoking, which is associated with negative affect and poorer self-reported health. Targeted interventions should be considered to reduce risky behaviors in this population.
Febrile neutropenia in the nationwide inpatient sample: In-hospital outcomes and impact of cormobidities in 2007-2012.
Authors: Abbasi Saqib , Nazha Bassel , Moussaly Elias , Manchanda Monika , Atallah Jean Paul 
Published: September 2018

e18103 Background: Febrile Neutropenia (FN) is associated with significant in-patient morbidity and mortality. The goal of this study is to describe the in-patient outcomes of febrile neutropenia as well as the impact of comorbid conditions through a large national dataset. Methods: Using the Nationwide Inpatient Sample (NIS) for years 2007-2012, FN was defined as ICD-9 codes 288.0x for a primary discharge diagnosis of neutropenia in conjunction with 780.61 and 780.6 for fever in cancer patients. Linear regression analysis assessed for annual trends in in-hospital mortality, length of stay (LOS), and cost of stay (COS). Seasonal variations in admission rates were evaluated using ANOVA. We employed univariate and multivariate logistic regression analysis to elucidate the relationship between common comorbid conditions and mortality. Results: Among 55,253 cancer patients (weighted N = 264,384) admitted with FN between 2007 and 2012, there is a mean decrease in LOS from 5.78 to 5.47 days (p < 0.0001), an increase in COS from $33,939 to $41,395 (p < 0.0001), and a 12-15% drop in hospital admissions in winter months. Mortality rate is unchanged annually (1.06-1.28%). Univariate analysis identified an increased risk of mortality associated with atrial fibrillation (OR = 4.06), coronary artery disease (OR = 2.09), congestive heart failure (OR 4.39), hypertension (1.20), COPD (OR 2.33) pancytopenia (OR 1.81), and adrenal insufficiency (OR 5.32). All remained significant on multivariate analysis, except hypertension and diabetes mellitus. Conclusions: Between 2007-2012, FN had a slight decrease in length of stay, unchanged in-patient mortality and a 22% increase in hospitalization costs. Our results are in line with recently presented analyses of the same database (Blood 2016 128:4762, Blood 2016 128:5904). Comorbid conditions are associated with higher in-patient mortality, with up to 5-fold increase for those with atrial fibrillation, congestive heart failure and adrenal insufficiency. Clinicians should consider the significant impact of such comorbidities. Additional vigilance and potentially prophylactic antibiotics following treatment should be considered in affected patients.
Survival associated with chronic obstructive pulmonary disease among elderly patients with non-small cell lung cancer.
Authors: Shah Shweta , Blanchette Christopher Michael , Kowalkowski Marc , Arthur Susan T , Coyle Joseph P , Howden Reuben 
Published: September 2018

e18107 Background: Lung cancer and chronic obstructive pulmonary disease (COPD) are among leading causes of morbidity and mortality worldwide. The association between pre-existing COPD and overall survival (OS) among patients with non-small cell lung cancer (NSCLC) remains unclear. We investigated the impact of pre-existing COPD and its subtypes: chronic bronchitis and emphysema on OS in elderly patients diagnosed with NSCLC at different stages. Methods: Using SEER-Medicare data, we identified patients diagnosed with NSCLC between January 1, 2006 and December 31, 2010, > 66 years of age, and continuously enrolled in Medicare Parts A and B in the 12 months prior to diagnosis. Pre-existing COPD in patients with NSCLC were identified using ICD-9 codes. Kaplan Meier method and log-rank tests were used to examine OS by COPD status and COPD subtype. Cox proportional hazards models were fit to assess the risk of death after cancer diagnosis while adjusting for baseline factors. Results: We identified 66,963 patients with NSCLC. Of these, 22,497 (33.60%) had documented COPD before NSCLC diagnosis. For each stage of NSCLC, median OS was shorter in the COPD compared to the non-COPD group (stage I: 692 vs 1130 days, P < 0.0001; stage II: 473 vs 627 days, P < 0.0001; stage III: 224 vs 229 days; P < 0.0001; stage IV: 106 vs 112 days, P < 0.0001). For COPD subtype, median OS for patients with pre-existing chronic bronchitis was shorter compared to emphysema across all stages of NSCLC (stage I: 672 vs 811 days, P < 0.0001; stage II 582 vs 445 days, P < 0.0001; stage III: 255 vs 229 days, P < 0.0001; stage IV: 105 vs 112 days, P < 0.0001). After multivariable adjustment, COPD patients exhibited an 11% shorter time to death compared to non-COPD patients (Hazard Ratio: 1.11, 95% Confidence Interval: 1.09—1.13). Conclusions: There were marked differences in early stage NSCLC, with a decrease in OS from stage I to stage IV in the COPD group. Patients with chronic bronchitis had shorter OS at every stage of NSCLC compared to emphysema. The results may help inform early detection strategies for NSCLC and treatment selection in early and advanced cancer.
ESKAPEade in hematological malignancies: Dare to review!
Authors: Gentille Sanchez Cesar Giancarlo , Sun Kai , Teegavarapu Purnima Sravanti , Puppala Mamta , Wong Stephen Tc , Qian Qin , Ibrahim Ibrahim Fuad , Rice Lawrence , Pingali Sai Ravi , Iyer Swaminathan Padmanabhan 
Published: September 2018

e18110 Background: Patients with hematological cancers are at a high risk for increasingly resistant and severe infections. The Infectious Diseases Society of America has defined commonly resistant bacteria as ESKAPE (Enterococcus, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter, Pseudomonas aeruginosa, Enterobacter/Enterobacteriaceae). We performed a retrospective review of the rate of ESKAPE infections, resistance profile, and outcomes in patients with various hematological malignancies at the Houston Methodist Hospital from 2006 to 2015. Methods: The patient data was obtained from METEOR (Methodist Environment for Translational Enhancement and Outcomes Research), a clinical data warehouse that contains records dating back to January 1, 2006 with over 3 million patients and over 10 million unique patient encounters. We queried for leukemia (AML, CML, ALL, CLL), amyloidosis and myelodysplastic syndrome (MDS) along with hospitalizations due to bacterial infections. Baseline demographics and overall outcomes were also obtained. Results: Out of 6017 patients with Hematological Malignancies, 632 patients were found; 322 had MDS, 225 had AML, 136 had CLL, 49 had ALL, 60 had CML, 97 had amyloidosis and 13 had an unspecified hematological cancer. Of 1091 infectious events, 60.5% were ESKAPE infections. The bacteria most frequently isolated were Enterococcus (24.7%), MRSA (19.8%) and Pseudomonas (18.0%). Patients with MDS (41.5%), AML (20.6%) and CLL (14.4%) were mostly affected. A prevalent resistance to levofloxacin was detected in gram positives and gram negatives (29-54%). Pseudomonas, E. coli, Proteus and K. pneumoniae showed a significant resistance to broad spectrum antibiotics including aztreonam (23-34%), cefepime (7-23%) and imipenem (22%). Proteus had the highest mortality rate (45.2%), followed by Enterococcus (44.2%) and Pseudomonas. (36.7%). Conclusions: Hematological cancers with risk for neutropenia such as MDS and AML were the most affected by ESKAPE. A significant resistance to levofloxacin, a prophylactic antibiotic, was seen. Gram negative pathogens had an increased resistance to broad spectrum antibiotics and higher mortality rates. New strategies for reducing ESKAPE in MDS and AML are required.