bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantifying gender ascertainment bias in hereditary cancer testing.
Authors: Chen Anthony , Anguiano Allison , Bernhisel Ryan , Brown Krystal , Gorringe Heidi , Manley Susan 
Published: September 2018

6516 Background: Historically, hereditary cancer genetic testing has been much more prevalent among women, in part due to gender-specific cancer risks associated with Hereditary Breast and Ovarian Cancer Syndrome (HBOC). Despite expanded genetic testing that includes hereditary cancer syndromes that affect both men and women, the gender gap still persists. Here we report on gender ascertainment bias in hereditary cancer testing by evaluating the proportion of test cancellations in men and women who were not affected with cancer at the time of testing. Methods: A commercial testing cohort was queried to identify individuals for whom genetic testing with a multi-gene pan-cancer panel was ordered between September 2013 and December 2016. Individuals who were ascertained for testing based on a clinical suspicion of HBOC or Lynch syndrome (LS) and did not have cancer at the time of testing were included. Test cancellations (i.e. a test order that did not yield any reported result) due to lack of insurance coverage were assessed, as this is directly related to clinical testing criteria. Results: Genetic testing was ordered for 259,919 individuals who did not have cancer at the time of testing, which included 6007 men (2.3%) and 253,912 women (97.7%). Overall, 21.2% of tests ordered for men were cancelled due to lack of insurance coverage, which is significantly higher than the cancellation rate among women (14.4%, p < 0.001). This trend was observed among individuals tested for suspicion of HBOC (18.7% for men vs. 13.2% for women; p < 0.001), but not for those tested for LS (26.6% for men vs. 25.1% for women; p = 0.137). Among those whose tests were not cancelled, the positive mutation rate was twice as high for men compared to women (9.6% vs 4.6%, respectively; p < 0.001). Conclusions: In this analysis, the proportion of genetic tests ordered was substantially biased towards women. Cancellation rates for men were significantly higher compared to women, while the mutation positive rate was twice as high. Although men and women who are unaffected with cancer have an equal probability of having a family cancer history that meets HBOC testing criteria, the data presented here suggests that there is a higher clinical standard for men to receive genetic testing.
Asymptomatic distant recurrence detection and survival in early stage breast cancer: A nationally representative study.
Authors: Schumacher Jessica R. , Neuman Heather B. , Zhang Ying , Yu Menggang , Vanness David J. , Si Yajuan , Burnside Elizabeth S , Ruddy Kathryn Jean , Partridge Ann H. , Schrag Deborah , Edge Stephen B. , Jacobs Elizabeth A , Havlena Jeffrey , Francescatti Amanda B. , Spears Patricia , Winchester David P , McKellar Daniel P. , Chang George J. , Kozower Benjamin D. , Greenberg Caprice Christian 
Published: September 2018

6520 Background: Breast cancer follow-up guidelines recommend imaging for distant metastases only in the presence of signs/symptoms. However, data supporting this recommendation predates the current era of improved imaging and targeted therapies based on molecular subtype. The objective was to assess the relationship between mode of distant recurrence detection and survival. Methods: A stage-stratified random sample of Stage II-III breast cancer patients diagnosed in 2006-7 was selected from NCDB records from 1,217 CoC-accredited facilities (10/hospital n = 10,853). Women were categorized by subtype: 1) ER or PR+/HER2-; 2) ER and PR-/Her2- (triple negative); 3) HER2+. Medical records abstracted for 5-years post-surgery supplemented NCDB data and assessed distant recurrence and mode of detection (prompted by signs/symptoms or surveillance imaging), imaging (chest CT, abdomen/pelvis CT/MRI, head CT/MRI, bone scan, PET/CT), death date. The relationship between mode of recurrence detection and days from initial cancer diagnosis to death was assessed using propensity-weighted multivariable Cox proportional hazards regression stratified by subtype. Propensity weights, based on receipt of surveillance systemic imaging, accounted for sociodemographic and tumor/treatment factors. Results: 5-year distant recurrence was 22.3% for triple negative, 14.8% HER2+, and 11.2% for ER or PR+/ HER2- patients. Asymptomatic imaging detected recurrence in 22.9% and signs/symptoms in 77.1%. Patients with asymptomatic as compared to sign/symptom detected recurrences had reduced risk of death in 5 years if triple negative (HR = 0.68, 95% CI = 0.50-0.93) or HER2+ (HR = 0.40, 95% CI = 0.24-0.65) with no significant association for ER or PR+/HER2- (HR = 1.2, 95% CI = 0.88-1.51). This translated to a between-group difference in weighted median survival of 5 months for triple negative and 13 months for HER2+ patients. Conclusions: This is the first nationally representative study to show a survival advantage with asymptomatic detection of distant metastases for patients, with the benefit limited to triple negative and HER2+ disease. Further research to confirm observational findings is warranted.
Mammography use in breast cancer survivors: An administrative claims study.
Authors: Ruddy Kathryn Jean , Sangaralingham Lindsey R. , Neuman Heather B. , Greenberg Caprice Christian , Freedman Rachel A. , Jemal Ahmedin , Mougalian Sarah Schellhorn , Hunt Katie N. , Haddad Tufia C. , Lemaine Valerie , Ghosh Karthik , Hieken Tina J. , Vachon Celine , Gross Cary Philip , Shah Nilay D. 
Published: September 2018

6531 Background: Annual mammography is recommended to screen residual breast tissue for new cancers and recurrent disease after treatment for early stage breast cancer. This study aimed to assess mammography rates over time in breast cancer survivors. Methods: We used administrative claims data from a large U.S. commercial insurance database, OptumLabs, to retrospectively identify privately- and Medicare Advantage-insured women with operable breast cancer who had residual breast tissue after definitive breast surgery between 2006 and 2015. We required coverage for at least 13 months following surgery. For each subsequent 13-month time period, we only included women without a loss of coverage, bilateral mastectomy, metastatic breast cancer diagnosis, or non-breast cancer diagnosis. We calculated the proportion of patients who had a mammogram during each 13-month period following breast surgery. We used multivariable logistic regression to test for factors associated with mammography in the first 13 months. Results: The cohort included 26,011 women followed for a median of 2.9 years (IQR 1.9-4.6) after surgery; 63.1% were less than 65 years of age, and 74.4% were white. In their first year of follow-up, 86% underwent mammography, but by year 7, this decreased to 73%. Fewer than 1% underwent MRI instead of mammography. In multivariable analysis, mammograms were less likely during the first year after surgery among women aged < 50 years (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.6 to 0.8), African Americans (OR, 0.7; 95% CI, 0.7 to 0.8), patients who underwent mastectomy (OR, 0.7; 95% CI, 0.6 to 0.7), and patients residing in the Western part of the country (OR, 0.9; 95% CI, 0.7 to 0.9). Those with 1-2 comorbidities were more likely (OR, 1.1; 95% CI 1.1-1.2) than those with none to have a mammogram during that period. Mammography use did not differ significantly by year of diagnosis (2006-2015). Conclusions: Even in an insured cohort, a substantial proportion of breast cancer survivors do not undergo annual surveillance mammography. Mammography use falls as the time from the early stage breast cancer diagnosis increases. Understanding factors associated with lack of mammographic screening may help improve survivorship care.
Impact of insurance status on treatment for stage 0-IV breast cancer.
Authors: Greenup Rachel Adams , Thomas Samantha Marie , Fayanju Oluwadamilola Motunrayo , Hyslop Terry , Hwang Eun-Sil Shelley 
Published: September 2018

6532 Background: Health insurance can influence utilization of cancer care. We sought to determine whether insurance status impacts treatment patterns and survival in women with stage 0-IV breast cancer. Methods: Women ages 18-69 years old, diagnosed with unilateral stage 0-IV breast cancer between 2004 and 2014 were selected from the National Cancer Data Base. Insurance status was categorized as Private, Medicare (65+ yo), Medicare (18-64 yo), Medicaid, or Uninsured. After adjustment for known covariates, generalized and binary logistic regression were used to estimate the association of insurance type with receipt of treatment. A multivariate Cox proportional hazards model was used to estimate the association of insurance status with overall survival. Results: A total of 610,450 women met inclusion criteria. Median age was 56 (48-63). Insurance status included: 72.1% Privately insured, 13.9% Medicare 65+, 4.8% Medicare 18-64, 7.1% Medicaid, and 2.1% Uninsured. Women with private insurance were more likely to present with stage 1 breast cancer, and less likely to present with stage 4 disease when compared to Medicaid or Uninsured patients (stage 1: 63.4%, 49.4%, 48.2%, p < 0.01; stage IV: 0.8%, 1.8%, 2.1%, p < 0.01). Risk of death was higher in uninsured or Medicaid patients when compared to those with private insurance (HR 1.52, 95% CI 1.41-1.64; HR 1.6, 95% CI 1.52-1.68). Receipt of chemotherapy and radiation did not differ between Medicaid, Uninsured, or Privately insured patients, but women without private insurance were more likely to receive neoadjuvant chemotherapy (OR 1.14, 95% CI 1.09-1.19; OR 1.16, 95% CI 1.07-1.25, respectively, p < 0.01). Uninsured women were more likely to undergo mastectomy without reconstruction (OR 1.57, 95% CI 1.49-1.65), and less likely to undergo unilateral or bilateral mastectomy with reconstruction than lumpectomy and radiation (OR 0.57, 95% CI 0.53-0.61; OR 0.35, 95% CI 0.32-0.39). Conclusions: Stage at diagnosis and risk of death were higher in Medicaid and uninsured breast cancer patients when compared to those with private insurance. Insurance status did not predict differences in receipt of surgery, chemotherapy, or radiation but did affect oncologic outcomes.
Does access to cancer drugs relate to survival benefit? A European study in countries with different economic status.
Authors: Wilking Nils Erik , Jönsson Bengt , Lindgren Peter , Wilking Ulla 
Published: September 2018

6535 Background: As new cancer drugs come at a high cost, it is of interest to examine if drugs with high impact on survival has a relative higher uptake compared to drugs with limited impact on survival in countries with limited resources (low Gross National Product; GDP/capita) versus countries with better resources (medium or high GDP/capita). Methods: Based on published clinical trial data, including ESMO- and ASCO value scales, we selected three drugs with high impact on survival and their main indications; imatinib/Chronic Myeloid Leukemia (CML), rituximab (some use outside oncology)/lymphoma and trastuzumab/breast cancer compared to everolimus/ renal cancer, sorafenib/renal cancer and bevacizumab/colorectal cancer as drugs with limited impact on survival. Countries in Europe were divided into three economic groups: upper-tier GDP/ capita 36,000 – 73,400 €; (Austria, Belgium, Denmark, Finland, Ireland, The Netherlands, Norway, Sweden, Switzerland); mid-tier GDP 22,800 – 35,400 €; (France, Germany, Italy, Spain, UK) low-tier GDP 5,800 – 18,100 € (Bulgaria, Croatia, Czech Republic, Greece, Hungary, Poland, Portugal, Romania, Slovakia, Slovenia). Sales data from IMS Health and epidemiological data from IARC Cancer Mondial, (WHO) were used. Access to drugs was measured as use in g/case (defined as cancer mortality in 2012) and includes total usage from introduction until end of 2014. Access in the upper-tier country group was set as 100% usage. Results: As seen in the table, access in mid-tier countries was 64-76% and low-tier countries 34-55% respectively for drugs with higher survival impact and access in mid-tier countries was 73-105% and low-tier countries 34-59% respectively, for drugs with lower survival impact. More detailed data on access in individual countries within each GDP/capita group will also be presented. Conclusions: Proven survival benefit did not affect spending on costly cancer drugs in countries with lower GDP. [Table: see text]
Comparison between Canadian and British oncology drug review recommendations and their impact on patient access.
Authors: Smith Matthew K. , Khan Omar Farooq , Yip Steven , Tang Patricia A. 
Published: September 2018

6537 Background: Access and funding for oncology medications in Canada and the United Kingdom are influenced by recommendations released by the pan-Canadian Oncology Drug Review (pCODR) and the National Institute for Health and Care Excellence (NICE), respectively. This study investigated variations between these organizations’ recommendations and the clinical implications these differences had on access to medications. Methods: The pCODR Drug Review and NICE Technology Appraisal Guidance databases were reviewed to identify all oncological drug recommendations made by both agencies between 2008 and 2016. Recommendations were matched and then evaluated according to an algorithm to identify clinically relevant differences that restricted access in one jurisdiction relative to the other. Length of time from drug submission to final recommendation by NICE and pCODR were compared using Wilcoxon rank sum tests, as was the length of time between regional funding approval. Results: Between 2008 and 2016, 31 medication indications were evaluated by both pCODR and NICE. For 12 indications, funding was only supported by one agency. Eight indications were approved by both agencies, but with clinically relevant differences in wording, with each agency making a more restrictive recommendation four times. Average time from submission to recommendation was faster for pCODR than NICE (213.8 days vs. 407.9 days; p < 0.001) but the average time to funding decision (see table) was similar (410.1 days in Canada vs. 407.9 days in the United Kingdom; p = 0.71). Conclusions: Although clinically relevant differences in recommendations do exist between NICE and pCODR, neither agency was consistently more restrictive. pCODR recommendations were made more quickly than NICE, but this did not translate into faster funding approval in Canada. Jurisdictional barriers exist for cancer patients which could be mitigated through harmonization and acceleration of drug review processes. [Table: see text]
Racial disparities in treatment and outcomes of colorectal cancer in young adults.
Authors: Alese Olatunji Boladale , Jiang Renjian , Shaib Walid Labib , Wu Christina Sing-Ying , Behera Madhusmita , El-Rayes Bassel F. 
Published: September 2018

6559 Background: The incidence of colorectal cancer (CRC) in young adults is increasing. Minority populations with CRC are known to have worse outcome. The objective of this study is to evaluate the impact of race on the outcome of young adults with CRC. Methods: Data were obtained from all US hospitals that contributed to the National Cancer Database (NCDB) between 2004 and 2013. Univariate and multivariate testing was done to identify factors associated with patient outcome. Kaplan-Meier analysis and Cox proportional hazards models were used for association between patient characteristics and survival. Results: A total of 83,449 patients between 18 and 50 years of age were identified. The mean age was 43.6 years (SD±6), with a male preponderance (53.9%). About 72% were non-Hispanic Whites (NHW) while African Americans (AA) made up 15.1%. Distribution across stages I-IV was 15.6%, 22.4%, 33.9% and 27% consecutively, similar among the races. 41.8% of NHW and 28.4% of AA had rectal cancers (p<0.001). Despite equally receiving standard of care (SOC) as per NCCN guidelines, AA had significantly lower 5year survival rates (58.8%) compared to Hispanics (64.8%) and NHW (66.9%; HR 1.42; 1.38-1.46; p<0.001). Patients with colon cancer had worse outcome compared to rectal cancer (HR 1.21; 1.18-1.24; P<0.001). In terms of survival, NHW (HR 0.85; 0.81-0.88; p<0.001) and Hispanics (HR 0.75; 0.70-0.79; p<0.001) were more likely to benefit from chemotherapy compared to AA. As expected, SOC utilization was associated with improved survival across all racial groups, especially in AA with HR of 0.64 (0.60 – 0.69; p<0.001). Conclusions: Despite comparable rates of standard of care utilization, AA young adults with CRC had worse outcomes compared to other races. Colon cancer was significantly more common in AA than rectal cancers, which may have contributed to their worse outcomes. [Table: see text]
Disparities in next generation sequencing in a population-based community cohort of patients with advanced non-small cell lung cancer.
Authors: Presley Carolyn Jean , Soulos Pamela R. , Chiang Anne C. , Longtine Janina A , Adelson Kerin B. , Herbst Roy S. , Nussbaum Nathan C , Sorg Rachael , Abernethy Amy Pickar , Agarwala Vineeta , Gross Cary Philip 
Published: September 2018

6563 Background: The use of next generation sequencing (NGS) in patients with advanced non-small cell lung cancer (NSCLC) is increasing. This study explored disparities in the use of NGS testing. Methods: This retrospective observational study utilized Flatiron Health’s longitudinal, demographically and geographically diverse database containing electronic health record data from 191 oncology practices across the U.S. We identified patients diagnosed with advanced (stages IIIB/IV or recurrent) non-squamous NSCLC who received first line treatment and either NGS testing or standard biomarker testing (e.g., EGFR, ALK) alone. NGS included any multi-gene panel testing > 30 genes. Logistic regression modeled the association between patient characteristics and receipt of NGS testing, accounting for clustering of patients by oncology practice. Results: Among 5,688 adults with advanced NSCLC, 4,813 (84.6%) patients received standard biomarker testing alone and 875 (15.4%) patients received NGS testing. The median age of the sample was 67y (IQR: 41-85), the majority was white (63.6%) vs. black (7.5%) vs. unknown (13.4%), and had a history of smoking (79.9%). Among the youngest patients ( < 45y), 31.5% received NGS compared to 11.3% among the oldest (76-85y; P < .001). Approximately 16% of white patients received testing, compared to 11.4% of black patients (P < .001). Patients with Medicaid received testing less often than commercially insured patients (11.7% vs 17.0%; P = .10). Patients had significantly lower odds of receiving NGS testing if they were older (≥75 vs. < 45 years of age; adjusted OR: 0.21, 95% CI: 0.13-0.34), black vs. white race (aOR: 0.63, 95% CI: 0.44-0.90) or were Medicaid vs. commercially insured (aOR: 0.54, 95% CI: 0.30-0.97). Conclusions: Significant age, race, and insurance-related disparities exist in the receipt of NGS testing among patients with advanced lung cancer in real world clinical practice.
What are patients’ biggest concerns? A patient reported outcome case-management system.
Authors: Warsame Rahma M. , Thompson Carrie A. , Hubbard Joleen Marie , Fonder Amie L. , Hobbs Miriam A. , Hwa Lisa , Kourelis Taxiarchis , Gonsalves Wilson I. , Croghan Katrina , Fruth Briant , Dispenzieri Angela , Sloan Jeff A. 
Published: September 2018

6572 Background: Cancer patients (pts) receive complex care that may cause physical, emotional, & financial sequelae. Current practice limits clinician time to address patient concerns. The Patient Reported Outcome Quality Of Life (PROQOL) system was developed as a self-reported electronic questionnaire to assess symptoms, QOL and provide data about bothersome issues. Our aim was to determine if the PROQOL system improves QOL without negatively impacting routine clinic workflow. Methods: Eligible pts had multiple myeloma, amyloidosis, head & neck or gynecologic cancer seen in Hematology/Oncology clinics at Mayo Clinic, and were stratified by stem cell transplant and active treatment status. Pts were randomized 2:1 to PROQOL system or usual care. PROQOL system was offered prior to every visit. Pts select from various categories about their single biggest concern, and receive a printed list of actionable resources based on selected concern. Clinicians also receive the PROQOL results to review with pts. Providers and pts randomized to PROQOL completed a “was it worth it survey” (WIWI). An 8 item Linear Analogue Self-Assessment was used to assess QOL. The study was powered to detect a 0.5 standard deviation difference in QOL between groups. Herein we report the planned results of first 6 months. Results: Among the first 118 pts accrued, 55% were female, median age was 63 (32-86), & 93% were on therapy. Median time from diagnosis to PROQOL was 26 months. The PROQOL system took 3.6 minutes to complete. Baseline median QOL (range) was 7 (3-10) for both groups. The most common PROQOL issue selected was “cancer & diagnosis” (36.5%) followed by “physical health” (35.3%). Specific concerns were related to treatment plan, prognosis, fatigue, sleep, and neuropathy. WIWI showed: 71% of pts thought it was worthwhile, 83% would participate again, 80% would recommend it, & 65% used resources provided. 80% of providers reported the PROQOL did not interfere with care & 75% believed the pt wellbeing may improve. Conclusions: Notably treatment plan & prognosis remain pts' greatest concern despite being over 2 year from diagnosis.The PROQOL system demonstrates integrated PRO reporting in clinic is quick & worthwhile to pts & providers.
Self-reported health and access to care among cancer caregivers: Analysis of the 2015 behavioral risk factor surveillance system (BRFSS).
Authors: Castellanos Emily , Nikpay Sayeh 
Published: September 2018

6573 Background: Caregivers play a vital role in the support and treatment of cancer patients. Caregiver well-being can impact patient-perceived quality of care. The study objectives were to compare self-reported health and access to care between cancer caregivers and non-caregivers, and to determine the relationship of caregiving burden to self-reported health and access to care. Methods: We used data from the Caregiver and Core Modules of the 2015 BRFSS, an annual federal survey of health-related behavior, health conditions, and preventive service use. Caregiver burden was assessed by time (hours per week and duration of caregiving) and task (personal care and household management tasks). Measures of self-reported health and access to care between cancer caregivers and non-caregivers were compared using t-test or Chi-Square testing. Associations of caregiver burden with self-reported health and access to care were assessed with linear and logistic regressions. Results: 1,910 cancer caregivers and 84,412 non-caregivers were included. Compared to non-caregivers, cancer caregivers were more likely to report inability to see a physician due to cost (15% vs 9%; p < 0.001), depression (25.0% vs 17.9%; p < 0.001), and poor mental health (mean days per month 5.7 vs 3.1; p < 0.001). Compared to caregivers with low task burden, those with moderate or high task burden reported both more poor mental health days (moderate ß = 1.8, 95% CI 0.5 – 3.1, p = 0.008; high ß = 2.0, 95% CI 0.6 – 3.3, p = 0.004) and increased likelihood of cost barriers (moderate OR 1.6, 95% CI 1.03 – 2.5, p = .035; high OR 1.8, 95% CI 1.2 – 2.9, p = .008). Increased time burden was associated with more poor mental health days (moderate ß = 1.5, 95% CI 0.2 – 2.7, p = .02; high ß = 4.4, 95% CI 3.3 – 5.6, p < .001) but not cost barriers. No differences in insurance, personal health provider, medical check-ups, or self-reported poor physical health were identified. Conclusions: Cancer caregivers are more likely than non-caregivers to report poor mental health, depression, and difficulty seeing a physician due to cost. Caregivers with high caregiving burden are at increased risk of experiencing poor mental health and cost barriers to medical care.