bluuebunny/crossref_metadata_2025_split huggingface dataset:
US-guided percutaneous radiofrequency versus microwave ablation for benign thyroid nodules: A prospective multicenter study.
Authors: Cheng Zhigang 
Published: September 2018

e17593 Background: To evaluate the clinical outcomes between radiofrequency ablation (RFA) and microwave ablation (MWA) in treating benign thyroid nodules (BTNs) with a prospective multicenter study. Methods: The prospective multicenter study achieved the registration of Chinese Clinical Trial Registry (Number: ChiCTR-ONRC-13003087). From January of 2013 to December of 2015, the total number of 1,252 patients with 1351 benign thyroid nodules (BTNs) at eight participating institutions was enrolled in the multicenter study. The ablation devices were applied in the study including RFA system of VIVA RF generator (VIVA RF generator, STARmed, Goyang, Korea) and MWA system of KY-2000 2450MHz microwave system (KY-2000, Kangyou Medical, Nanjing, China). All the procedures of RFA or MWA were performed under ultrasound (US) guidance in each center. Results: The number of target nodules treated by RFA and MWA were 687 in 649 cases and 664 in 603 cases, respectively. For the estimation of efficacy, the mean maximal diameter reduction ratios (MDRRs) of RFA vs. MWA groups at the 3rd, 6th, 12th month and last follow-up were 36.4±17.3% vs. 36.0±23.0% (p = 0.765), 54.1±22.7% vs. 49.3±28.0% (p = 0.005), 64.5±22.1% vs. 57.9±40.1% (p = 0.008) and 65.5±26.0% vs. 58.2±33.5% (p = 0.028), respectively. The mean volume reduction ratios (VRRs) of RFA vs. MWA groups at the 3rd, 6th, 12th month and last follow-up were 67.6±20.3% vs. 64.4±43.5% (p = 0.143), 84.1±13.5% vs. 78.4±48.2% (p = 0.016), 89.6±20.0% vs. 82.5±49.7% (p = 0.035) and 91.3±12.6% vs. 81.1±70.4% (p = 0.045), respectively. For the estimation of safety, for all the complications and side effects encountered at the peri-ablation and follow-up period in two groups, the major, minor complication and side effect rates of RFA vs. MWA group were all no statistical significances with 4.78% vs. 6.63% (p = 0.156), 2.00% vs. 2.49% (p = 0.562) and 4.93% and 4.64% (p = 0.812), respectively. Conclusions: As a conclusion of the prospective multicenter study, both RFA and MWA under US guidance percutaneously are safe and effective techniques for selected patients with BTNs. Larger MDRR and VRR can be achieved in RFA group than the ones in MWA group at 6-month and later follow-up. Clinical trial information: ChiCTR-ONRC-13003087.
Improving lung cancer diagnosis at a large urban minority-based medical center: Where can we do better?
Authors: Su Christopher , Chau Vincent , Bhargava Amit , Shah Chirag D , Ohri Nitin , Gucalp Rasim A. , Packer Stuart H. , Perez-Soler Roman , Halmos Balazs , Cheng Haiying 
Published: September 2018

e18017 Background: Lung cancer diagnosis is a complex process with barriers to care which are more apparent in underserved communities. We examined factors affecting lung cancer diagnosis in an underserved urban community, including demographics, lung cancer screening, and survival outcomes. Methods: All new lung cancer diagnoses with confirmed pathology at an urban academic medical center in 2015 were identified. Retrospective chart review was conducted and time from initial abnormal imaging to tissue sampling was calculated. Analyses were performed with χ2, ANOVA, linear regression, and log-rank tests. Results: In 2015, 229 patients were diagnosed with lung cancer. 36 patients (16%) expired or were referred to hospice due to clinical deterioration without treatment. 162 patients (71%) were ultimately started on therapy. Patients were predominantly Black (38%), Hispanic (30%), underserved (mean per capita income $21729), and enrolled in Medicare or Medicaid (83%). Only 62% of the patients had a PCP at time of diagnosis. Most presented at an advanced stage (63% III or IV) and 88% were former/current smokers. 78 patients (48%) were eligible for low-dose CT screening but only 9 (12%) completed screening. Screening completion was correlated with established PCP (p = 0.012). Time from abnormal imaging to biopsy was 31±40 days without significant difference across age, gender, race, ethnicity, income, insurance, and primary language. Cancers diagnosed in the inpatient vs. outpatient setting were found at a more advanced stage (p = 0.002) and had lower survival (p < 0.001). Hispanics had better survival (p = 0.008) despite lower per capita income and higher incidence of smoking. Conclusions: There was no significant difference in imaging to biopsy time across major demographic factors and they are unlikely to be a source of poor outcomes. However, the advanced stage and poor prognosis of cancers detected in the inpatient setting, proportion of patients who expired or were referred to hospice immediately after presentation, and disparity between screening eligible and completed patients underscores the critical importance of increasing lung cancer screening and establishment of primary care.
Racial disparities in NCI Cancer Center (NCI-CC) care for multiple myeloma (MM).
Authors: Fiala Mark A , Ailawadhi Sikander , Schroeder Mark A. , Stockerl-Goldstein Keith , Vij Ravi , Wildes Tanya Marya 
Published: September 2018

e18061 Background: Despite a favorable genetic profile, African-Americans (AAs) with mm have poorer outcomes secondary to inferior treatment. NCI-CCs provide the highest-quality of care and attendance has been associated with better outcomes in many cancers. AAs have greater access to NCI-CCs proximally; however, they attend these facilities at lower rates than their white peers. The impact of attendance at NCI-CCs on mediating racial disparities in mm outcomes has not been reported on to date. Methods: We reviewed cases of mm the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database from 2000-2011 who were enrolled in Medicare Part A and B > 1 year prior to diagnosis, excluding cases enrolled prior to age 65 and those where mm diagnosis occurred post-mortem. Any center designated a NCI-clinical or -comprehensive center in 2002, 2005, or 2010 was considered a NCI-CC; attendance was defined as 2 or more claims on separate dates (MEDPAR and Outpatient files) from a NCI-CC in the 12 months following mm diagnosis. Logistic regression was performed to determine if race was associated with attendance, Cox regression to determine the association of attendance with survival. Results: 21,843 cases were analyzed; the median age was 77 years; 80% were white, 15% AA/Black. Overall NCI-CC attendance was low, only 11% of the population. Compared to white patients, black patients had a 13% decreased odds (aOR 0.87, 95% CI 0.75-0.99) of NCI-CC attendance after controlling for age, gender, socioeconomic status, geographic, and overall health variables. Attendance was associated with a 28% decrease risk for death (aHR 0.72, 95% CI 0.68-0.76), but had little impact on black-white outcome disparities. Black patients had a 9% increase in risk (aHR 1.09, 95% CI 1.04-1.13) after controlling for NCI-CC attendance. Conclusions: Black patients with mm have lower NCI-CC attendance. This may be related to referral bias and/or patient declining referral. NCI-CC attendance was associated with superior outcomes; however, controlling for attendance did not mediate black-white outcome disparities suggesting that racial treatment disparities pervade beyond access to NCI-CCs.
Disparities in cancer outcomes across age, sex, and race/ethnicity among pancreatic cancer patients.
Authors: Tramontano Angela , Nipp Ryan David , Kong Chung Yin , Pandharipande Pari , Dowling Emily , Schrag Deborah , Hur Chin 
Published: September 2018

e18071 Background: Age, sex, and racial/ethnic disparities exist for several malignancies, but these relationships are understudied in pancreatic adenocarcinoma (PDAC). We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to determine whether these disparities persist in survival and treatment after adjusting for demographic, clinical, and treatment characteristics. Methods: Our study includes PDAC patients (pts) diagnosed from 1992-2011 in the SEER-Medicare database. We used Cox regression models to compare survival across age, sex, and race/ethnicity, stratified by non-metastatic and metastatic cancer. We used logistic regression to compare differences in chemotherapy, radiation, and surgery receipt across age, sex, and race/ethnicity. We adjusted for marital status, urban location, socioeconomic factors, SEER region, comorbidities, cancer stage, lymph node status, tumor location, tumor grade, diagnosis year, and chemotherapy, radiation, and/or surgery receipt. Results: Of 20,896 PDAC pts (median diagnosis age = 75 years; 56% female), 84% were White, 9% Black, 5% Asian, and 2% Hispanic; 53% had metastatic cancer. Among non-metastatic pts, adjusted Cox regression demonstrated that older pts had worse survival compared with younger pts (HR: ≥1.1 for all ages [reference = 66-69 years vs. 70-74, 75-79, 80-84, 85+], p < 0.01 for all); we found no survival differences between sexes. Black (HR: 1.1, p = 0.01) and Hispanic (HR: 1.2, p < 0.01) pts had worse survival compared to White pts. Among metastatic cancer pts, adjusted Cox regression demonstrated that older pts (HR: 1.1 for age 85+ [reference = 66-69 years], p < 0.01) had worse survival than younger pts, and males (HR: 1.1, p < 0.01) had worse survival than females. There were no racial/ethnic differences. There were disparities in treatment received; older age and minority race/ethnicity were associated with lower likelihood of receiving chemotherapy, radiation, and/or surgery. Conclusions: Age, sex, and racial/ethnic disparities in survival outcomes and treatment received exist for PDAC pts; these disparities persist after adjusting for differences in demographic, clinical, and treatment characteristics.
A novel global health fellowship elective in oncology in Rwanda: A multi-faceted model in education.
Authors: Lansigan Frederick , Costa Cristiana A. , Mpanumusingo Egide , Kigonya Catherine , Butonzi John , Sebahungu Fidel , Shyirambere Cyprien , Mpunga Tharcisse , Haley Jennifer , Figueroa Kurt , Park Paul , Davis Thomas H. , Chamberlin Mary D. 
Published: September 2018

e18086 Background: Despite the rising burden of cancer, opportunities for global health education (GHE) at the fellowship level are lacking in hematology and oncology (HO). The Geisel School of Medicine at Dartmouth (GSMD) is pioneering a supervised one-month elective in Rwanda for HO fellows enrolled in U.S. programs. The goals are to expose fellows to a wider spectrum of disease states, improve clinical acumen, cultural sensitivity, and learn about health delivery in low-resource countries, while providing educational support for the local staff in a multidirectional learning paradigm. Methods: In partnership with the Rwandan Ministry of Health (MOH) and Partners in Health (PIH), GSMD created a one month elective rotation at the Butaro Cancer Center of Excellence (BCCOE) in Rwanda. HO Fellows with an interest in GHE apply to work in the outpatient clinic and inpatient wards in at BCCOE under direct supervision by GSMD faculty to provide input on cancer management including diagnosis, treatment, and chemotherapy administration. Fellows and attendings give lectures to hospital faculty and staff on topics requested by the leadership of BCCOE and participate in weekly telemedicine tumor boards. Fellows are evaluated using ACGME clinical competencies. Feedback from the Rwandan staff is obtained through customized evaluations. Results: The HO fellow gained exposure to advanced cancers including HIV-related malignancies, rare sarcomas and gestational trophoblastic disease, adhered to locally developed staging and treatment pathways, and gained confidence in guiding medical decisions. Fellows and faculty gave didactic presentations and provided bedside teaching. The local MOH and PIH staff gained new insight about approaches to management of complex disease states. This program promoted a multidirectional exchange of ideas related to patient care, disease states, and collaborative research projects. Conclusions: The institution of a global health fellowship elective in oncology has measurable benefits to HO fellows, cancer care providers in Rwanda and American faculty sub-specialists. This novel educational program will help to bridge the gap in global health disparities in a multifaceted approach.
Effects of patient navigation on satisfaction with cancer care: A systematic review.
Authors: Jean-Pierre Pascal 
Published: September 2018

e18088 Background: Patient navigation (PN) is a model of health care coordination designed to ameliorate health disparities by reducing barriers to achieving optimal health outcomes. Systematic reviews that evaluate whether PN is associated with higher patient satisfaction with cancer care are lacking. Methods: We conducted a systematic review to synthesize evidence of comparative studies evaluating the effectiveness of PN programs to improve satisfaction with cancer-related care. We included studies reported in English that: 1) evaluated a PN intervention designed to increase satisfaction with cancer care; and 2) involved a randomized controlled trial (RCT) or observational design. We abstracted data from studies using standardized forms, and evaluated these studies for methodological quality. Data were summarized qualitatively and synthesized under a random effects model. Results: The initial search yielded 831 citations, of which 3 RCTs and 6 observational studies met inclusion criteria. These nine studies involving 4,200 surveyed patients revealed either a neutral or positive effect in patient satisfaction in the majority of studies of PN and cancer-related care. However, only 5 studies (1 RCT and 4 observational) had adequate datato include in the meta-analysis. Methodological quality of eight of the included studies ranged from weak to moderate to strong, with half rated as weak. Findings of the RCT showed a statistically significant increase in satisfaction with cancer care involving PN [standardized mean difference (SMD) = 2.30; 95% Confidence Interval (CI): 1.79, 2.80, p < .001]. Pooled results from non-RCTs showed no significant association between PN and satisfaction with cancer-related care (SMD = 0.39; 95% CI: -0.02, 0.80, p = .06). Conclusions: More systematic reviews are needed to characterize the relationship between PN and satisfaction with cancer-related care across the cancer care continuum and across different types of cancer.
Treatment related mortality (TRM) for AML pts managed at a non-transplant, safety net hospital.
Authors: Goparaju Krishna , O'Brien Timothy E. 
Published: September 2018

e18092 Background: Induction treatment for AML is associated with severe, life threatening toxicities. An accepted criterion for TRM is the 4 week mortality rate. A recent 18 yr study of AML pts treated with 3+7 induction regimens at SWOG institutions revealed an overall TRM at 4 weeks of 11%. Management of AML pts at non-transplant centers is controversial due to concerns over lower volumes, possibly leading to excess TRM. Over a 15-year period TRM was evaluated at a safety net, non-transplant center and compared to a national benchmark. Adherence to national guidelines for diagnostic testing was also assessed. Methods: MetroHealth Medical Center is a safety net hospital with a mission statement requiring all pts to be seen regardless of their ability to pay. Using tumor registry data, all cases of AML from 2001- 2016 were identified. Demographic data, 4 week TRM and compliance with standard diagnostic evaluation per NCCN guidelines were assessed.. Results: 67 cases were identified; average age was 59 (25-89), with equal distribution in gender. 73% were Caucasian, 18% African American, 4.5% Asian and 4.5% Hispanic. All but one (who went into hospice) had standard diagnostic tests sent (flow cytometry, cytogenetics and, for those with normal karyotyping, all had molecular testing for FLT-3 ITD, NPM-1, CEPBA and c-kit). Of the 67 patients, 5 received azacitadine, 2 received decitabine and 12 did not get treated due to co-morbidities and/or poor performance status. 48 patients received induction chemotherapy, of which 5 had APL appropriate therapies and the rest (43) received 3+7 induction regimens. For these 48 pts the 4 week mortality was 10%. Of those who received induction chemotherapy, 27% had favorable, 23% intermediate and 50% had poor risk molecular studies. Conclusions: A 15 yr review of outcomes during AML induction at a non-transplant, safety net institution revealed a TRM rate similar to a national benchmark, in spite of a relatively high percentage of poor risk cases. There was also good adherence to national diagnostic standards. Given the potential changes in the US healthcare delivery system which may result in more pts being seen at safety net institutions, these findings may have implications for future allocation of care.
New and emerging therapies for relapse/refractory multiple myeloma: Impact of education on practice behaviors.
Authors: Roc Anne , Turell Wendy , Dingli David 
Published: September 2018

e18096 Background: Newly approved and emerging agents with novel mechanisms of action present unique challenges to treating patients with relapsed/refractory multiple myeloma (RRMM), including keeping abreast of rapid and ever-aggregating data on their safety, tolerability and efficacy. To address these challenges, an education activity focused on new and emerging therapies for RRMM was developed and learner responses were evaluated to determine the impact of education. Methods: A live-online 1-hour video panel discussion with slides, polling, and live questions was produced in 2016 and made available on-demand at OMedLive.com for 6 months. Survey responses (pre-, post-, 8 weeks post-activity), polling responses, and live questions asked were tracked to measure engagement, lessons learned, and additional education gaps. Results: 51 of 288 learners completed all pre/post/follow-up surveys, 67% of which reported the activity positively impacted patient experience or outcome and 61% reported it positively impacted their clinical practice. These learners reported improvements in their ability to: assess the relative safety and efficacy of emerging agents (50%), differentiate available agents and their relative efficacy (50% with proteasome inhibitors, 39% with monoclonal antibodies), see the potential benefit of HDAC inhibitors (35%), use combination regimens (29%), and adjust treatments for patients who’ve experienced disease progression (29%). As the result of education, 95 of 288 learners reported commitments to change in regards to: medical/practice knowledge (95%), care attitudes (89%), practice behavior (76%), and patient clinical outcomes (81%). Learners also demonstrated improved competence via a case scenario which required identifying the optimal next step for a patient with biochemical progression, and improved knowledge on the characteristics of daratumumab, elotuzumab, and selinexor. Conclusions: New and emerging therapies promise to improve the lives of patients with RRMM, but complicates the already difficult task of managing the disease. Ongoing education on RRMM is recommended and can yield immediate and sustained gains in knowledge, competence, and performance.
Association of diabetes with colorectal cancer treatment and outcomes.
Authors: Iyengar Arjun , Gold Heather Taffet , Nicholson Joseph , Becker Daniel Jacob 
Published: September 2018

e18112 Background: Diabetes mellitus (DM) is associated with an increased incidence of colorectal cancer, but the impact of diabetes on colorectal cancer (CRC) prognosis and treatment patterns remains unknown. As outcomes in both CRC and DM have improved, appropriate co-management of the two diseases has become a priority to help patients live longer and healthier. Methods: A systematic search of PubMed, Embase, and CINAHL databases was performed to evaluate/assess the association of diabetes with colon cancer treatment patterns and outcomes, including recurrence rates (RR), disease free survival (DFS), colon cancer-specific (CSM) and all-cause mortality (ACM). We included English language peer-reviewed studies through November 2016 following the preferred reporting items of systematic reviews and meta-analyses (PRISMA) method. We applied STROBE quality criteria and conducted a random-effects meta-analysis. An inconsistency index (I2) was used to estimate the heterogeneity between studies. Results: After reviewing 2,611 reports, 35 studies were included that described an association of DM with CRC treatment patterns or outcomes. A meta-analysis of 14 studies that assessed (ACM) among 146,129 patients demonstrated an increased risk for ACM for CRC patients with DM (OR 1.28, 95% CI 1.16-1.42, I2 = 80%, P < .00001). No statistical significance was found in comparing 4 studies that looked at CSM (OR 0.91, 95% CI .72-1.14, I2 = 89%, P = 0.42). Analysis of 4 studies that assessed DFS found lower DFS in patients with DM (OR 1.75, 95% CI 1.33-2.31, I = 3%, P < .0001). Aggregating 3 studies that evaluated RFS demonstrated no clear association of DM and RFS(OR 1.12, CI 95% 0.91-1.38, I = 64%, P = .27). No consistent treatment discrepancies were noted in 6 studies that assessed the impact of DM on various CRC treatment modalities (receipt of surgery, chemotherapy, radiation). Conclusions: CRC patients with diabetes are at a greater risk for ACM and have worse DFS compared to those without DM. Analysis was limited due to study heterogeneity. We did not find consistent evidence that CRC is treated differently in patients with DM. Further study is warranted to clarify the mechanism of poor outcomes in CRC patients with DM and to improve survival.