bluuebunny/crossref_metadata_2025_split huggingface dataset:
Equity in access to tyrosine kinase inhibitors among veterans diagnosed with renal cell carcinoma.
Authors: Lynch Julie Ann , Lynch Kristine E. , Filipski Kelly Kristin , Berse Brygida , Rivera Donna , Chang Ji Won , Becker Daniel Jacob , Efimova Olga , DuVall Scott 
Published: September 2018

e18051 Background: Tyrosine kinase inhibitors (TKIs) have dramatically improved outcomes of advanced renal cell carcinoma (RCC) patients, although complete remission is uncommon. Disease-specific survival in RCC varies by race/ethnicity, but race is not an independent predictor of survival within single-payer healthcare systems, pointing to the importance of access to treatment. We analyzed patient-level utilization of three TKIs (sunitinib, sorafenib, and pazopanib) among veterans with RCC. Methods: In this retrospective cohort study, we used data from Department of Veterans Affairs (VA) Corporate Data Warehouse to identify veterans diagnosed with RCC from 2006 to 2015 and exposed to TKIs, and to obtain their demographic and clinical information. The distribution of patients’ characteristics across treatments was evaluated using chi square and t-tests. Results: Of 2,410 patients exposed to TKIs, 956 (40%) received more than one TKI. Sunitinib was prescribed to 1,761 (73%) patients, pazopanib to 766 (32%), and sorafenib to 600 (25%) patients. The use of sorafenib declined steadily over time, from 37% of patients diagnosed in 2006 to 2% of those diagnosed in 2015, while the use of pazopanib grew from 8% to 38%, respectively. The comparison group were unexposed patients in Stage IV RCC (N = 1,144). Patients exposed to targeted treatments were significantly younger at diagnosis than those with no exposure (mean [M] age 65 years, SD 9 vs. m = 70 years, SD 10; p < 001). There were no statistically significant racial/ethnic or gender differences between patients exposed and unexposed to TKIs. Exposed patients had significantly higher body mass index (BMI) than unexposed (M = 29.6, SD 6 vs m = 27.9, SD 6, respectively; p < 0.01). Receipt of TKI was positively correlated with both surgery and chemotherapy, and negatively correlated with Charlson comorbidity index (p < 0.01). Conclusions: We documented equal access to TKIs treatment within the VA among RCC patients of different ethnic backgrounds and gender. Treatment with TKIs was correlated with younger age and fewer comorbidities, but higher BMI. We observed trends in use of individual TKIs, with more recently approved pazopanib gradually replacing sorafenib and sunitinib.
An exploration of how a countries' HTA process can affect patient access.
Authors: Jaksa Ashley , Pontynen Anson , Bastian Alexander 
Published: September 2018

e18052 Background: Drugs in the USA become available from the moment of FDA approval. Access to oncology therapies outside of the USA may be delayed by regulatory and additional payer HTA processes. This study aimed to examine differences in oncology conditions that may impact time from regulatory approval to an HTA reimbursement decision in countries with mandatory HTA. Methods: Oncology HTAs (N = 569) for medicines approved by the EMA, Health Canada, and the Therapeutic Goods Administration (Australia) were matched on indication with HTAs from France, Germany, Canada, England, Scotland, and Australia. Resubmissions were excluded. The date of the first reimbursement decision was subtracted from the date of the regulatory approval to determine the time to issue a reimbursement decision. Trends by disease were examined. Results: The time between regulatory approval and reimbursement decision was significantly longer for solid-state oncology drugs than for hematology oncology drugs (mean 344 days vs. 280 days, respectively; p = 0.03). Within hematology oncology, Non-Hodgkin’s Lymphoma had the shortest time to a decision (229 days; n = 37) while Myelofibrosis had the longest (411 days; n = 3). For solid-state diseases, Sarcoma had the shortest time (5 days; n = 2) and Small-cell Lung Cancer had the longest (752 days; n = 5) time to a decision. Conclusions: Time to patient access to oncology medications varies by disease condition, which may reflect disease-related factors that impact assessment. The time to a decision for a hematology medicine was approximately two months shorter than the time to a decision for a solid-state medicine. It is possible that unmet need, budget impact, or competitive features within hematology conditions are driving the speed of assessments in these medicines. Further research is needed to determine why there are differences in time to decisions by oncology disease conditions.
Disparities in resection of hepatic metastases in colon cancer.
Authors: Neuwirth Madalyn G. , Epstein Andrew J , Karakousis Giorgos , Mamtani Ronac , Paulson Emily C. 
Published: September 2018

e18062 Background: Evidence suggests that resection of synchronous hepatic metastases (SHM) in Stage IV colon cancer is safe and can improve survival in select patients. Little is known, however, about the use of hepatic resection in this setting on a population level. Methods: A retrospective cohort study was performed of Stage IV colon cancer patients during 2000-2011 in SEER-Medicare data who had diagnosis codes confirming SHM. Univariate and multivariate logistic regression were used to identify patient factors related to receipt of hepatic resection. Results: There were 11,351 patients with colon cancer and SHM. 465 (4.1%) underwent surgical hepatic resection. The proportion increased steadily over time from 2000-2003 (3.5%) to 2009-2011 (5.1%) (p = 0.03). Patients who were older with higher comorbidity burden were less likely to undergo hepatic resection (Table 1). Additionally, the odds of hepatic resection were 30% lower for African-American patients than for white patients (OR 0.70, p = 0.05). Odds of hepatic resection were 44% lower for patients from ZIP Codes with > 20% poverty than for patients from areas with < 5% poverty (OR 0.56, p < 0.001). Interestingly, among patients who underwent no surgical treatment at all, only 12% saw a surgeon after diagnosis. This number increased over time from 7.7% in 2000 to 15.9% in 2011 (p < 0.001). Similar disparities noted above were seen with regard to being evaluated by a surgeon. Conclusions: Despite evidence supporting the safety and efficacy of hepatic resection in the setting of SHM, few patients are seen by surgeons and go on to receive hepatic surgery. Additionally, access to hepatic resection is notably lower for African Americans and patients from areas with higher poverty rates. [Table: see text]
Racial and social disparities on aggressiveness of end-of-life cancer care in a rural academic center.
Authors: Namireddy Praveen , Macherla Shravanti , McClain James Thompson , Muzaffar Mahvish 
Published: September 2018

e18063 Background: Aggressive cancer care at the end of life (EOL) can impact quality of life and have major economic burden. The purpose of this study was to determine the aggressiveness of EOL cancer care, and its relation to race, gender and social factors in Eastern North Carolina with a high rural and minority population. Methods: This is a retrospective analysis of 401 stage 4 solid tumor patients who died between 2011 and 2014 at Vidant Medical Center. Aggressiveness of care was calculated by a composite score adopted from Earle et al. Scores range from 0 to 7 with higher scores indicating more aggressive EOL care. 1 point was given to each indicator of aggressiveness in the last 30 days of life: ED visits ≥2, hospital admissions ≥2, any ICU admission, hospitalized days ≥14, new chemotherapy, hospice care ≤ 3 days, and any chemotherapy in the last 14 days. Results: Among 401 patients, 217 (54%) were white and 178 (44%) were black. The mean composite score for aggressiveness (CSA) for whites was 1.18 and for blacks it was 1.87 (p<0.001). In the last 30 days of life, a higher proportion of blacks had ≥ 2 ED visits 28% vs 13%(p<.0001), ≥ 2 hospital admission 23% vs 13%(p=0.001), any ICU admission 29% vs 16%(p=0.0002), chemotherapy in the last 14 days 30% vs 20%(p=0.001), and ≥ 14 hospitalized days 35% vs 21%(p<0.001) compared to whites. More whites were enrolled in hospice compared to blacks 53% vs 45% (p<0.001). Correlation analysis using Fit Y by X model showed statistically significant differences between CSA (score ≤ 3 and >3) and other variables such as whites vs blacks p <0.001, females vs males p=0.0006, not married vs married p<0.0001, and no family support vs family support p<0.0001. Conclusions: Male, unmarried and black patients were associated with higher CSA. Patients who were white, married and with family support had higher likelihood of enrolling in hospice. [Table: see text]
PD-L1 expression profile and immunotherapy (IO) experience in African American (AA) and Hispanic (H) lung cancer (LC) patients: Addressing disparities at a minority-based academic cancer center.
Authors: Shum Elaine , Su Christopher , Zhu Changcheng , Gucalp Rasim A. , Haigentz Missak , Packer Stuart H. , Baker Cheryl , Eng Yoko , Ravera Elizabeth , Browne Royston , Perez-Soler Roman , Halmos Balazs , Cheng Haiying 
Published: September 2018

e18073 Background: Immune checkpoint inhibitors have changed the treatment paradigm for metastatic LC. Minority populations are under-represented in large IO clinical trials. Among 989 pts with newly diagnosed LC at Montefiore Medical Center - a community-based academic center from 2014-2015, 330 (33%) were AA and 195 (20%) were H. In line with practice-changing clinical studies, PD-L1 expression testing and IO have been incorporated into LC treatment. Methods: Pts receiving IO and/or had PD-L1 testing between 1/1/14-12/31/16 were identified from records obtained from pathology, pharmacy, oncology clinics and Clinical Looking Glass. Retrospective chart review was conducted. PD-L1 testing was performed using 22C3pharmDx IHC. Results: We identified 111 pts with LC who received IO and/or had PD-L1 testing, with a median age of 66. 55% were female. Based on race, 52 (47%) were AA, 24 (22%) were White, 26 (24%) were Other, and 9 (8%) were race unknown. Based on ethnicity, 30 (27%) were H, 73 (66%) were non-H and 8 (7%) were ethnicity unknown. 82% were former/current smokers. Adenocarcinoma was the dominant histology (60%). The majority were EGFR WT (91%) and ALK neg (98%). PD-L1 testing was performed in 67 (60%), including 32 (29%) AAs and 20 (18%) Hs. Archival tissue was used in 63%. PD-L1 TPS > 50% was found in 30%, 1-49% in 24%, < 1% in 37%. 62 pts received IO, including 26 (42%) AAs and 18 (29%) Hs. Nivolumab was the most commonly used agent (77%). In AAs, 8 (31%) received IO as 1st line, 13 (50%) as 2nd line, 5 (19%) as 3rd line and above. In Hs, 1 (5%) received IO as 1st line, 10 (56%) as 2nd line, 7 (39%) as 3rd line and above. Immune-related adverse events (IRAEs) were reported in 31% of AAs and 39% of Hs. Data analysis on survival is ongoing. Conclusions: Unlike the low numbers of minority pts in large clinical trials, we found no significant difference in PD-L1 testing and IO across racial and ethnic groups treated at our center. Compared to large clinical trials, we observed lower rates of IRAEs in our cohort. Our current and ongoing observations in these populations may have future implications in narrowing health disparities based on race/ethnicity.
Long-term survival in chronic lymphocytic leukemia after first primary malignancy in the United States.
Authors: Bista Amir , Uprety Dipesh , Ghimire Subash , Giri Megha , Shah Binay Kumar 
Published: September 2018

e18090 Background: There has been significant improvement in survival among patients with primary Chronic Lymphocytic Leukemia (CLL) in recent years but, not much is known about survival among CLL developed after a first primary malignancy. Methods: SEER 18 database, 2015 submission, was used to calculate 5 and 10 year relative survival (RS) by period survival modeling method for 1993 to 2012, with division of the period into 4 cohorts of 5 years each. SEER*Stat software from National Cancer Institute was used to calculate relative survival (RS) for 4 different periods of 5 years duration. The trend in survival for cases with CLL as second primary cancer (CLLSPC) was evaluated using COX proportional hazard method using Cansurv software and also compared with that of primary CLL cases. Results: A total of 8731 patients with CLLSPC were included in the study, which represents 14.5% of all cases of CLL. The median age at diagnosis was 75 years. Median time to diagnosis of CLL was 50 months after diagnosis of first primary malignancy. Prostate cancer, breast cancer and colorectal cancer were 3most common primary cancers. 5-year and 10-year RS improved significantly in the year 2008-2012 compared to 1993-1997 (59.3% to 70.2%,P 0.044 and 40.1% to 50.6%, p 0.045). In subgroup analysis, significant improvement in 5-year and 10-year RS was seen in females and ≥ 80 years age group but no significant improvement was observed in males and age group 60-79 years. Survival among CLLSPC was significant worse compared to first primary CLL in all periods, even after adjusting for age and sex. Conclusions: CLLSPC represents about 14.5% of all CLL cases. Relative survival among patients with CLLSPC is gradually improving but still lags behind that of CLL as first primary cancer.
Variations in inpatient stays for non-metastatic HER2- breast cancer (BC), non-small cell lung cancer (NSCLC), and colorectal cancer (CRC) in a real world setting.
Authors: Malin Jennifer , Byfield Stacey DaCosta , Chastek Benjamin , Korrer Stephanie , Horstman Thomas , Newcomer Lee N. 
Published: September 2018

e18099 Background: We aim to compareprevalence and duration of inpatient stays during the most commonly used chemotherapy regimens for BC, NSCLC, and CRC in a commercially insured population. Methods: This analysis used clinical data obtained from a prior authorization program for chemotherapy linked with administrative claims data from 6/1/2015 to 5/31/2016. Clinical data included cancer type, stage at diagnosis, relevant biomarkers, and evidence of progression/relapse. Eligible patients included 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 percent of patients experiencing an inpatient stay and number of inpatient days were tracked from the first claim for chemotherapy until end of treatment due to discontinuation, death or change in treatment, with remaining patients censored at 5/31/2016 or end of enrollment. Results: There were 1612 HER2- BC, 237 NSCLC, and 386 CRC patients who completed therapy during the study period. Incidence and inpatient stay days per 100 patient months for the most common regimens for each cancer are summarized in the table. Conclusions: The rates and duration of inpatient stays varied substantially across the most commonly used therapies for BC, NSCLC and CRC. These data show the importance of systematically incorporating the impact of hospitalizations alongside other clinical outcomes in treatment choice in routine clinical practice. As the database grows over time, these data will help clinicians and patients better evaluate regimen choices for various cancers. [Table: see text]
Outcomes of cancer patients with takotsubo cardiomyopathy.
Authors: Guddati Achuta Kumar , Kumar Gagan , Shapira Iuliana , Joy Parijat Saurav 
Published: September 2018

e18101 Background: Chemotherapy induced cardiomyopathy is an important complication of some chemotherapeutic agents. The stress of a cancer diagnosis and ongoing chemotherapy may contribute to cardiac morbidity in these patients. The burden of Takotsubo Cardiomyopathy (TCP) in cancer patients is unknown. The incidence of TCP and related outcomes in cancer patients was investigated in this study. Methods: The 2007-2013 National Inpatient Sample (NIS) was analyzed for patients with a prior and new diagnosis of TCP with and without malignancy. Risk factors for mortality were adjusted for associated conditions by multivariable logistic regression analysis. Results: From 2007 through 2013, an estimated 122,750 adults were admitted with a diagnosis of TCP. In 2013, the incidence of admissions in US of patients with coexisting TCP and malignancy was 1.13%. Admissions in 34,957 patients were for a primary diagnosis of TCP with 91.7% females; overall, 665 (2.1%) had solid organ cancer, 237 (0.74%) had hematological malignancy and 354 (1.11%) had metastatic cancer. Patients admitted for TCP with coexisting malignancy had a significantly higher mortality (13.8% vs. 2.9%, p < 0.0001), length of stay (7 vs. 4 days, p < 0.0001) and total charges ($29291 vs. $ 36231, p < 0.0001), compared to those with no malignancy. In patients with a primary diagnosis of TCP and without any underlying malignancy, males had a higher mortality (4.02% vs. 1.03%, p < 0.0001) whereas there was no gender difference in mortality in those with coexisting malignancy (6.25% vs 6.45%, p = 0.965). On multivariable logistic regression analysis, risk factors associated with mortality were solid cancer (OR 3.43, p = 0.008), stroke (OR 18.33, p < 0.0001), venous thromboembolic disease (OR 4.52, p = 0.004), malnutrition (OR 2.41, p = 0.006) and heart failure (OR 1.918, p = 0.004). Conclusions: Outcomes are significantly worse in patients with TCP and solid malignancy. Hence, this patient population must be regarded as high-risk and early diagnostic consideration for TCP is warranted. Early intervention may help lower mortality, decrease resource utilization and reduce the health care costs in these patients.
Outcome of gastrointestinal cancer patients (pts) after ICU admission: The Abington Memorial Hospital (AMH) experience.
Authors: Malik Faizan , Ali Naveed , Jafri Syed Imran Mustafa , Naglak Mary , Patel Rajeshkumar , Fidler Christian , Cohen Steven J. 
Published: September 2018

e18108 Background: Based on prior studies, cancer pts admitted (atd) to ICU have poor outcome but gastrointestinal(GI) cancers have not been studied separately. We evaluated outcomes of GI cancer pts receiving active therapy (Rx) who were admitted to the ICU with the goal of informing physicians and pts regarding goals of care. Methods: We retrospectively evaluated pts with GI cancer on active chemo Rx in past 6 months who were admitted to the ICU from 2011-2016. Out of 375, 115 pts met the inclusion criteria. (85 = CRC, 30 = other GI malignancy). Results: The mean age was 71 (51% males). 75% stage 4, 42% had liver, 28% peritoneal, and 21% lung mets. The median duration of the last chemo dose was 2 wks. The median ICU length of stay was 3 days. 25% had neutropenia on admission. 64% had prior cancer related surgery, and 31% had prior radiation. 23% were atd due to cancer progression (CP), 19% due to potentially reversible cancer complications (pRCC), and 57% due to therapy complications (TC).Most common admitting diagnoses were: pneumonia (25.9%), abdominal infection (27%), PE/DVT/MI (20%), febrile neutropenia (10%). During ICU stay, 29% had ventilator dependent respiratory failure (VDRF), 53% had sepsis, 43% had renal failure (RF) and 17% had liver failure(LF). Median survival after ICU admit was 2 weeks (0-75). 15.5% were DNR at ICU admission and 82.8% were full code. 55.2% had palliative talk. After DC, 38.8% went back on Rx and 41% chose hospice. Readmission was 15.5%. In-hospital mortality (IHM) was 24.1% overall, and highest in those with LF (50%, p = .008), sepsis, and RF (34% each, p = .048). IHM was 33% in pts with CP (p value-0.201), 31% in patients with a pRCC (p-value 0.204), 18% in pts with a TC(p-value 0.092), and 52% in pts with VDRF(p-value 0.000). Overall, 56% were dead at 30 days, 65% at 90-days and 73% at 180 days. Conclusions: Our study suggests that in-hospital, 30-, 90- and 180-day mortality in GI cancer patients on active Rx admitted to the ICU was high, particularly in patients admitted with progressive cancer and/or with organ dysfunction. Most patients were full code and had not had prior documented GOC discussions. These results highlight the importance of early realistic GOC discussions for this population.
Survival associated with cachexia among SEER-Medicare beneficiaries with lung cancer.
Authors: Shah Shweta , Noone Joshua , Blanchette Christopher Michael , Arthur Susan T 
Published: September 2018

e18117 Background: Lung cancer is the leading cause of cancer death in the United States. It is estimated that 60% of lung cancer patients are afflicted with cancer-associated cachexia syndrome (CACS) and approximately 10% of these patients will die due to CACS. We examined the impact of CACS on survival among lung cancer elderly patients. Methods: We conducted a retrospective study using SEER-Medicare data. Patients were included if diagnosed with first primary lung cancer between January 1, 2005 and December 31, 2010, at least 66 years of age, and continuously enrolled in Medicare Parts A and B in the 12 months prior to diagnosis. We identified cachexia in lung cancer patients using ICD-9 codes. Descriptive statistics were used to identify population characteristics. Propensity score (1:1 nearest neighbor) matching was performed between cachectic and non-cachectic lung cancer patients to compare survival. Results: We identified 84,518 lung cancer patients. Of these, 2,536 (3%) developed CACS after lung cancer diagnosis. The most common comorbid conditions among cachectic and non-cachectic groups were chronic obstructive pulmonary disease (50% versus 45.62%), congestive heart failure (8.56% versus 13.38%), diabetes (7.41% versus 14.75%), peripheral vascular disease (3.82% versus 6.85%), and renal disease (3.63% versus 6.14%). Propensity score 1:1 matching for confounding bias and adjustment for immortal time bias resulted in a cohort of 3734 matched patients. Eighty-eight percent of patients in the cachectic group died during the follow-up period compared to 78% in the non-cachectic group. Median survival time among non-cachectic lung cancer patients was significantly longer than cachectic lung cancer patients (log-rank p < 0.0001). Specifically, median survival in non-cachectic patients was 201 days compared to 92 days among cachectic patients. Conclusions: The occurrence of CACS is independently associated with a significant decrease in survival among lung cancer elderly patients. The results of this study may be useful for identifying healthcare burden and planning treatment modalities for this population.