bluuebunny/crossref_metadata_2025_split huggingface dataset:
National population-based study of racial variation in characteristics and outcomes of young breast cancer patients: Analysis of temporal trends.
Authors: McClain James Thompson , Mosquera Catalina , Namireddy Praveen , Muzaffar Mahvish 
Published: September 2018

e18068 Background: Breast cancer outcomes correlate with racial and socioeconomic status. Efforts to reduce disparities in breast cancer among vulnerable populations has had limited success. We sought to examine trends of racial and socioeconomic factors and its impact on outcome in young breast cancer patients. Methods: Using the Surveillance, Epidemiology, and End Results database, we identified female patients aged 20-35 with invasive breast cancer diagnosed from 1990-2012. We performed univariate, multivariate and survival analysis. Variables included patient age, race, stage, receptor status, surgery type and year of diagnosis. Results: A total of 18,999 women were identified. Mean age was 31.7. 80.8% were white and 19.1% were black. A higher percentage of blacks had stage III/IV disease (34% v 27%) and ≥ 4 positive nodes (19% v 16%) compared to whites. 54% of whites were ER receptor positive while 46% of blacks were ER receptor positive (p<0.0001). Analysis of American Community Survey attributes indicated white patents were more likely to live in counties where ≤15% of households were below the poverty line (64% v 45%) and where ≤15% of the population had less than a high school education (35% v 28%) compared to blacks. 31.2% were diagnosed in 1990-2000 while 68.7% were diagnosed in 2001-2012. 5 year disease specific survival (DSS) was 79.1% among all patients diagnosed from 1990-2000 and 84.2% among patients diagnosed from 2001-2012 (p<0.0001). In each time period, white patients had significant difference in 5 year DSS compared to black patients. While the 5 year DSS for white patients improved from 80.9% to 86.3% (p<0.0001), the 5 year DSS improvement for black patients from 1990-2000 to 2001-2012 did not reach statistical significance (71.3% vs 75.7%, p=0.24). Conclusions: Demographic and economic factors are associated with outcomes in young breast cancer patients. Absolute DSS has improved over consecutive time periods, but the improvement was not significant among blacks. More effort is needed to evaluate and address disparity in these patients. [Table: see text]
Health care disparities among octogenarians and nonagenarians with stage III lung cancer.
Authors: Cassidy Richard John , Zhang Xinyan , Patel Pretesh R , Shelton Joseph W , Tian Sibo , Steuer Conor Ernst , Pillai Rathi Narayana , Ramalingam Suresh S. , Owonikoko Taofeek Kunle , Force Seth D , Fernandez Felix G , Gillespie Theresa Wicklin , Curran Walter J , Higgins Kristin Ann 
Published: September 2018

e18075 Background: Octogenarians and nonagenarians with stage III lung cancer are underrepresented in randomized trials that established the standard of care therapy of concurrent chemoradiation (CRT). The purpose of this study was to investigate factors predictive of and the impact on overall survival (OS) following CRT among patients ≥80 years old with stage III non-small cell lung cancer (NSCLC) in the National Cancer Data Base (NCDB). Methods: In the NCDB, patients ≥80 years old from 2004 to 2013 with stage III NSCLC were queried. Logistic regression, Kaplan-Meier method, and Cox-proportional hazard regression analyses were performed as well as propensity-score matched (PSM) analysis to reduce treatment selection bias. Results: A total of 12,641 stage III NSCLC patients ≥80 years old were identified with complete treatment and OS records; 7,921 (62.7%) received no treatment, 1,153 received definitive radiation alone (9.1%), and 3,567 (28.2%) received CRT. On multivariable analysis (MVA), black race, female gender, advancing age, residence in a lower-educated county, adenocarcinoma histology, and patients with stage IIIB tumors were associated with receiving no anti-cancer therapy while treatment at an academic facility and lower comorbidity status were associated with receiving anti-cancer treatment (all p < 0.05). On MVA, male gender, advancing age, non-adenocarcinoma histology, higher tumor grade, larger tumors, advancing T and N stage, stage IIIB tumors (vs. IIIA), delayed start to CRT, and not receiving CRT were associated with worse OS (all p < 0.05). OS rates at 1 and 5 years was 53.7% and 10.1% respectively for patients receiving CRT compared to 16.4% and 3.3% respectively for all other therapies (p < 0.01). PSM analysis confirmed that not receiving CRT was associated with worse OS (HR = 1.23, 95% CI 1.11-1.34; p < 0.01). Conclusions: A significant portion of patients ≥80 years old with stage III NSCLC do not receive treatment. Black race, female gender, advancing age, and residence in a lower-educated county were associated with not receiving therapy. In this NCDB series, OS is higher in patients ≥80 years old receiving CRT, even when adjusting for patient- and tumor-related factors.
A pilot study of a comprehensive financial navigation program in cancer survivors.
Authors: Shankaran Veena , Leahy Tony , Steelquist Jordan , Watabayashi Kate , Singleton Erin , Gallagher Kathleen , Balch Alan James , Linden Hannah M. , Schwartz Naomi , Ramsey Scott David , Overstreet Karen 
Published: September 2018

e18079 Background: Although financial toxicity is associated with poorer clinical outcomes in cancer survivors, few studies have attempted to address this toxicity. We developed a financial navigation program in collaboration with our partners (Consumer Education and Training Services (CENTS) and Patient Advocate Foundation (PAF)) to improve patients’ knowledge about cancer treatment costs, provide financial counseling, and help with out-of-pocket expenses. We conducted a pilot study to assess feasibility and early impact of this program. Methods: Patients (pts) within 1 year of a solid tumor diagnosis and 6 months of chemotherapy and/or radiation were recruited at the Seattle Cancer Care Alliance. Pts received a financial education course followed by monthly contact with a CENTS financial counselor and PAF case manager for 6 months. We measured program adherence, self-reported financial burden, anxiety about costs, program satisfaction, and type and amount of assistance provided. Results: We consented 34 pts (median age 60.5), the majority of whom were white (85%) and commercially insured (50%). Participants (n = 20) and non-participants (n = 14 who withdrew or were lost to follow up early on) did not differ in age, race, gender, education, income, or insurance type. Debt, income declines, and loans were reported by 55%, 55%, and 30% of pts. High financial burden and anxiety about costs (4 or 5; Likert scale) were reported by 37% and 47% of pts. High satisfaction with the education course, CENTS counselors, and PAF case managers were reported by 73%, 80%, and 91% of pts. CENTS counselors assisted pts most often with budgeting, retirement planning, and medical bill questions. PAF case managers assisted pts with gaps in insurance, debt or cost of living issues, and employment rights and disability applications. A total of $7,667 ($1,267 for pts and $6,400 for institutions) was obtained through charitable entities. Conclusions: Our findings confirm that a financial navigation program is feasible to implement, associated with high satisfaction, and provides concrete assistance to pts in navigating the cost of cancer care. Future work will focus on improving program adherence and measuring its impact on financial and clinical outcomes.
Comparison of rural versus urban residence for symptoms and quality of life in recurrent ovarian cancer: Baseline analysis of GOG-0259, an NRG Oncology/GOG study.
Authors: Belcher Sarah M. , Sereika Susan M. , Dodson Zan M. , Mattos Meghan K. , Hagan Teresa , Donovan Heidi AS 
Published: September 2018

e18083 Background: Women with recurrent ovarian cancer (OC) experience a wide range of cancer- and treatment-related symptoms that negatively impact quality of life (QOL). Studies have reported healthcare disparities by geographic residence related to distance, time, and financial barriers to accessing high quality care. However, no studies have evaluated the impact of residence on symptoms and QOL in women with OC. Therefore, our objectives were to evaluate whether geographic residence (urban versus rural) is associated with symptoms and QOL in a sample of women with recurrent OC. Methods: The Center for Health Equity Research and Promotion conceptual framework guided analyses of baseline GOG-0259 data. We mapped zip codes to RUCA commuter codes and compared sociodemographic and clinical variables between rural and urban groups using two-sample t and chi-square tests. We used MANCOVA, adjusted for age and marital status, to test for associations between residence and symptoms (Symptom Representation Questionnaire) and QOL (Functional Assessment of Cancer Therapy-Ovarian). Results: Rural (n = 122, 25%) and urban (n = 374, 75%) women were similar in all sociodemographic and clinical comparisons except for marital status (83% vs. 70% married, p = .003). Women reported moderate symptom severity (M = 5.5, SD = 2.3) and QOL scores similar to other OC studies (M = 108.4, SD = 19.5). In multi-variate analyses, age and marital status were both associated with symptoms; marital status was associated with QOL. Geographical residence was not associated with either symptoms or QOL. Conclusions: Counter to previous research, there were no symptom or QOL disparities based on geographic residence in this sample. Possible explanations to be explored in future research include a) cooperative group selection bias for women with good access to care regardless of geographic residence and b) protective effects of marital status on symptoms and QOL.
Is cancer history associated with asset ownership, debt, and net worth in the United States?
Authors: Doroudi Maryam , Coughlan Diarmuid , Banegas Matthew P. , Yabroff K Robin 
Published: September 2018

e18085 Background: Financial hardships experienced by cancer survivors in the United States have become significant social and public health issues. Few studies have assessed the underlying financial holdings, including ownership and values of assets and debts, of individuals following a cancer diagnosis. This study assessed the association between a cancer history and asset ownership, debt, and net worth. Methods: We identified 1,603 cancer survivors and 34,915 individuals without a history of cancer aged 18-64 from the nationally representative Medical Expenditure Panel Survey (MEPS) Household Component and Asset sections (years 2008-2011). Descriptive statistics were used to assess demographic characteristics, cancer history, asset ownership, debt, and net worth by cancer history. Regression analysis was conducted to assess the association between cancer history and net worth, stratified by age group (18-34, 35-44, 45-54, and 55-64 years) to reflect stages of the life-course. Results: Asset ownership was least common for cancer survivors and individuals without a cancer history in the 18-34 age group and most common in the 55-64 age group. Cancers survivors aged 45-54 had a lower proportion of home ownership than individuals without a cancer history (59% vs 67%; p = 0.001). Nearly 20% of all respondents reported at least some debt. The proportion of cancer survivors with debt was higher than individuals without a history of cancer, especially in the 18-34 age group (41% vs 27%; p < 0.001), although it did not vary by age group. When asset and debt values were combined to assess net worth, cancer survivors aged 45-54 were significantly more likely to have a negative net worth and significantly less likely to have a positive net worth than those individuals without a history of cancer in fully adjusted models. Findings on net worth were similar in the 18-34 age group, although only statistically significant in unadjusted and partially adjusted models. Conclusions: We found that cancer history is associated with asset ownership, debt, and net worth, especially in those aged 45-54 years. Longitudinal studies to assess patterns of financial holdings throughout the cancer experience are warranted.
Appendiceal adenocarcinoma: Analysis of SEER database.
Authors: Chandana Sreenivasa Rao , Shah Chintan 
Published: September 2018

e18097 Background: Appediceal cancers (AC) are rare, and often found on appendectomies. Adenocarcinomas represents approximately two-thirds of all AC. We performed the analysis of SEER database to understand the overall incidence and survival trends. Methods: We analyzed SEER database: Incidence - SEER 18 RegsResearch Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2015 Sub (1973-2013 varying). Cases diagnosed of AC between 1988 and 2013 were identified. Trend of incidence rate was calculated. Relative survival rates (RSR) were calculated stratified by age, gender, race, stage, histological subtypes which were divided into mucinous, non-mucinous and signet ring cell carcinoma (SRCC). We calculated survival difference for patient diagnosed before and after 2000. Results: Age adjusted incidence rate of appendiceal adenocarcinoma was 0.4 cases per 100,000 person years. Overall incidence rate increased on average 3.7% per 100,000 person years (P < 0.05). The highest increase was seen in SRCC (4.8% per 100,000 person years). Survival was worst in SRCC (5 years RSR-28.40%) compared to other types (5 year RSR- 61.0% and 52.90% for mucinous and non-mucinous carcinoma (P < 0.01). Survival significantly improved for patients diagnosed after 2000 for mucinous (5 years RSR -51.90% and 64.30%) and SRCC (5 year RSR-18.0% and 31.0%), respectively before and after 2000 in each category. No improvement in survival was found in non-mucinous carcinomas since 2000. While survival among different histological types was not different for localized disease, it was significantly better for regional or distant stages in mucinous cancers when compared to non-mucinous cancers (P < 0.01). Elderly patient ( > 65 years) showed significantly poor survival for mucinous and non-mucinous carcinomas, while there was no variation in survival based on age for SRCC. Moreover, females showed significantly poor survival (P < 0.05) compared to males for SRCC, while no variation in survival based on gender for other types. Survival was not different among different races. Conclusions: Incidence of appendiceal adenocarcinomas is increasing. The highest increase is seen in SRCC which has the worst survival. Survival from mucinous adenocarcinomas has improved significantly in last decade.
Variations in cost for non-metastatic HER2- breast cancer (BC), non-small cell lung cancer (NSCLC), and colorectal cancer (CRC).
Authors: Malin Jennifer , Byfield Stacey DaCosta , Chastek Benjamin , Korrer Stephanie , Horstman Thomas , Newcomer Lee N. 
Published: September 2018

e18106 Background: We aim to quantify economic outcomes of the most commonly used chemotherapy regimens for BC, NSCLC, and CRC in a commercially insured population. Methods: This analysis used clinical data from a prior authorization program for chemotherapy regimens linked with administrative claims data from 6/1/2015 to 5/31/2016. Clinical data included cancer type, stage at diagnosis, and biomarkers. Eligible patients were commercially insured members with a prior authorization request for one of the most commonly used NCCN recommended regimens for BC, NSCLC and CRC. Outcomes, including total healthcare cost and cost of chemotherapy were tracked from first claim for chemotherapy until end of treatment due to discontinuation, death or change in treatment. Patients were censored at 5/31/2016 or end of enrollment. Results: There were 1612 BC, 237 NSCLC, and 386 CRC non-censored patients who received therapy during the study period. Mean (SD) total and monthly drug costs and total health care costs for the most common regimens by cancer are summarized in the table. Conclusions: The relative value of the most common therapies for BC, NSCLC, and CRC varied significantly depending on the metric used underscoring the importance of comparing total healthcare costs when assessing the value of therapies. Information on these and other regimens will increase as the database grows over time. [Table: see text]
Qualitative study of patient perspectives on B-cell non-Hodgkin lymphoma: Impact of patient education.
Authors: Roc Anne , Howson Alexandra , Turell Wendy , Lunning Matthew Alexander 
Published: September 2018

e18109 Background: This qualitative study explored the impact of an online, patient-focused education activity on B-cell NHL ( http://www.cancercoachlive.com/ ), developed by the Leukemia and Lymphoma Society, University of Nebraska, and PlatformQ Health, to improve patient knowledge on B-cell NHL and offer strategies to enhance quality of life through better disease and side effect management. Methods: 12 qualitative interviews were conducted using a semi-structured interview guide. Questions focused on knowledge of B-cell NHL epidemiology, prognosis, and typical presentation; diagnostic and imaging tests; efficacy and side effects of treatments used to treat B-cell NHLs; and actions to improve quality of life and overall health. Interviews were recorded and transcribed verbatim, and analyzed using constant comparative method with software support (NVivo 11, QSR International). Results: Participants, aged 43-78 (mean 60 years, 8 female), were diagnosed with a B-cell NHL 2-24 years prior to interview. Participants demonstrated understanding of B-cell NHL, with good recall on typical presentation of B-cell lymphoma, the importance of blood tests and laboratory/diagnostic procedures and what to expect during these tests. Six participants recalled traumatic experiences with bone marrow biopsy and suggest additional education for newly diagnosed patients. Participants were knowledgeable about treatment options covered by the program (i.e. active surveillance, chemotherapy, radiation therapy, stem cell transplant), and were interested in more information on treatment options across the B-cell disease trajectory. Not all participants could recall information on targeted therapies from the program, and there was low awareness about clinical trials as a treatment option, indicating need for further education. Conclusions: Overall, participants had a positive impression of the education activity. They judged the content to be comprehensive, accurate, and realistic. Participant descriptions suggest that education continues to play a role in allaying fears and anxieties even among patients who have learned to live with B-cell NHL and who have been managing their disease for several years.
Impact of care at Memorial Sloan Kettering Cancer Center (MSKCC): A comprehensive cancer center on overall survival (OS) in patients (pts) with AJCC stage IV pancreas adenocarcinoma (PDAC).
Authors: Boland Fiona , Cheema Ahmad , Lowery Maeve Aine , Yu Kenneth H. , Varghese Anna M. , Epstein Andrew S. , Abou-Alfa Ghassan K. , Kelsen David Paul , O'Reilly Eileen Mary 
Published: September 2018

e18128 Background: PDAC has a rising incidence and relatively static mortality rates. Current cytotoxic regimens confer median survivals of 8.5- 11 months (Von Hoff, Conroy, et al. NEJM 2013, 2011). National Cancer Institute-designated Comprehensive Cancer Centers potentially allow greater access to multidisciplinary consultation for complex cancer care. Although the widespread benefits of NCICCCs are acknowledged, there is limited data demonstrating superior outcomes for patients treated at these centers. Methods: Patients with stage IV PDAC, diagnosed between 01/01/13 and 12/31/14, were identified and followed until death or 12/31/2016. These patients had care centralized to MSKCC and the analysis was conducted to evaluate key patient (pt) and disease characteristics, systemic therapies and outcomes.Survival times were calculated from the date of diagnosis. Results: N=391 pts identified, 210 males (54%), 181 females (46%). Median age 66 years (range 27-91). Table 1 outlines key points. For entire cohort, median overall survival (mOS): 11.4 + 9 months, 1-year (yr) and 2-yr survival rates (SR) of 48% and 15.1% respectively. N= 165 (42%) received mFOLFIRINOX-based regimen as 1st-line therapy with mOS 13.2 + 8.9 months, 1-yr and 2-yr SR of 59.4.% and 20% respectively. N= 118 (30.1%) received gemcitabine + nab-paclitaxel- based regimen as 1st line therapy had a mOS of 11.6 + 9 months with 1-yr and 2-yr SR of 49.1% and 16.2% respectively. Conclusions: At MSKCC, a major referral center for PDAC, outcomes for stage IV disease compare favorably to contemporary trial outcomes with notable 2-yr survivorship (long-term survival analysis of MPACT trial showed 1-yr and 2-yr SR of 35% and 10% respectively). Contributing factors likely reflect multidisciplinary expertize, patient selection and biases. Centralized care for complex illnesses may improve outcomes. [Table: see text]
A retrospective evaluation of unplanned hospital admission rates for women with ovarian cancer.
Authors: Dioun Shayan M , Miller Eirwen Murray , Tymon-Rosario Joan , Kuo Dennis Yi-Shin , Nevadunsky Nicole Suzanne 
Published: September 2018

e18129 Background: Unplanned admission following chemotherapy is a measure of quality cancer care. Large retrospective datasets have shown admission rates 10-35% in women with ovarian cancer receiving chemotherapy. It is unclear whether the Oncology Care Model is sustainable based on these admission rates. We sought to evaluate the rate and risk factors for hospital admission following chemotherapy in our racially diverse urban population. Methods: After IRB approval, all patients with epithelial ovarian cancer who received chemotherapy at our institution from 2005-2016 were identified. Charts were retrospectively reviewed for clinicopathologic data. Categorical variables were compared with chi-squared and continuous variables with the student t-test. Results: 222 evaluable patients were identified. 37 (17%) patients had unplanned admissions following initial chemotherapy. Indications for admission included neutropenic fever (9), abdominal pain (15), metabolic disturbances (2), infection (3), and other (8). The median number of days from chemotherapy to admission was 8 (IQR 7-18.5). No significant differences were seen in race, medical co-morbidities, age, or BMI in admitted patients. Stage and primary neoadjuvant chemotherapy were predictive of admission. Conclusions: Unplanned hospital admission rates following initial chemotherapy in our racially diverse patient population are consistent with previously reported rates. Though age and medical co-morbidities did not predict admission, stage and primary neoadjuvant chemotherapy were predictive of subsequent admission. The Oncology Care Model may not account for hospital admission rates of this magnitude and further investigation is needed to identify predictors of hospitalization and poor outcomes. [Table: see text]