bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real-world multi-target stool DNA adherence in an underserved and vulnerable prison patient population.
Authors: Kasselman Jeffrey , Greene Mallik , Pew Timo , Johnson William , Ozbay Burak Burak , Brooks Durado , Limburg Paul J. 
Published: June 2024

e15632 Background: In 2024, colorectal cancer (CRC) is estimated to be the fourth most diagnosed cancer, as well as the second leading cause of cancer death in the United States. While adherence to regular CRC screening has been suboptimal in the general population, this holds to be especially true in populations that are medically underserved. Non-invasive tests, such as the guideline recommended multi-target stool DNA (mt-sDNA) test, offer a more accessible option to increase screening participation in difficult to reach populations. Herein, we evaluated adherence to CRC screening in a cohort of prisoners who received the mt-sDNA test at a Nebraska Department of Corrections facility in Nebraska. Methods: This was a retrospective cohort study in a small prison population. Participants included both males and females between the ages of 45 and 75 years who underwent CRC screening evaluation at the prison’s medical center between June 1st – December 31st, 2023 and were offered multiple CRC screening options, including the mt-sDNA test. No inducements were provided for completion of the mt-sDNA test. Baseline demographics were collected for cohort description. The primary variable of interest was mt-sDNA test return rate (adherence), defined as completion of the mt-sDNA test within 60 days of kit receipt. We also evaluated mt-sDNA test results in secondary analyses. Results: Once inclusion criteria were applied, the resulting analysis cohort included 129 patients who were first time mt-sDNA screeners. The cohort was largely male (96.9%) and between the ages of 50-64 years (78.3%). Overall mt-sDNA test adherence was 95.3%, with the average time to test completion being 20 days. No significant difference was seen in test completion among males and females (95.2% vs 100%, respectively). Completion rates increased with patient age, at 90.9% (45-49 years), 95% (50-64 years), and 100% (65-75 years). The shortest time to completion in the population was observed amongst patients who were females (18.8 days), and those between the ages of 45-49 years (17.1 days). Negative and positive mt-sDNA test results were observed in 82.9% and 17.1% of the cohort, respectively. Conclusions: CRC screening with the mt-sDNA test in this single-center study of incarcerated participants yielded exceptionally high adherence rates within 60 days of kit receipt. Assessment of follow up colonoscopy rates for test-positive participants is ongoing. While based on a relatively small sample size in this initial study, the mt-sDNA test exhibited favorable completion rates in a difficult to reach population, supporting further efforts to characterize patient, provider, and system-level benefits that may be obtained through broader adoption of this highly accessible screening approach in this challenging healthcare setting.
Analysis of patch-based GCN risk score distribution corresponding to gene mutations in colorectal cancer using whole slide images.
Authors: Liang Li , Lin Jie , Deng Xikai , Qiu Weihao 
Published: June 2024

e15650 Background: Colorectal cancer (CRC) is one of the most common malignancies, with the third highest incidence and the second highest mortality in the world. Risk scores are typically employed to predict outcomes such as disease risk, prognosis, or treatment response. Risk scores are usually calculated by combining biomarkers or genetic variants with statistical models, such as logistic regression or Cox proportional hazards models, and then observe the relationship between genetic variations and survival time through survival analysis. We have constructed a deep learning model based on Graph Convolutional Networks (GCNs), which is capable of predicting risk scores using Whole Slide Images (WSIs). Statistical analyses were applied to explore the distribution of risk scores associated with different variants in colorectal cancer. Methods: We performed risk scores prediction on a total of 384 samples from TCGA-COAD and TCGA-READ using our patch-based GCN model. We analyzed the distribution of risk scores in colorectal cancer samples and investigated the effects of gene mutations in key pathways on these risk scores. Results: Risk score predictions by our patch-based GCN model were conducted on 384 samples, revealing that the maximum, minimum, median, mean, and standard deviation of risk scores were -0.78, -1.89, -1.34, -1.34, and 0.20, respectively. The data overall conformed to a normal distribution ( p < 0.05 ). We selected core genes in key pathways combined with top ten genes with the highest mutation frequency in colorectal cancer for statistical analysis to explore the correlation with the predicted risk scores. These gene mutations were found in a total of 346 patients. The results indicated that mutations in the TP53 and OBSCN genes led to significant differences in risk scores as predicted by our model ( p < 0.05 ). The risk scores based on gene mutations also have significant differences and consistent trend in these genes. Conclusions: Our results indicate the risk scores generated by the patch-based GCN model have the consistent trend with the risk scores generated by mutation information of core genes in colorectal cancer. Whether risk scores based on digital pathology prediction can replace mutation detection in predicting patient survival status requires further exploration.
Broad-spectrum antibiotic use and risk of early-onset colorectal cancer.
Authors: Chao Chun , Xu Lanfang , Chubak Jessica , Figueiredo Jane C. , Getahun Darios , Cannavale Kimberly L. , Gilfillan Alec , Wu Bechien U 
Published: June 2024

e15653 Background: The incidence of early-onset colorectal cancer (eoCRC) diagnosed under age 50 is rising in the United States, but the underlying causes are largely unknown. Use of broad-spectrum antibiotics can induce intense gut dysbiosis, which is strongly implicated in CRC carcinogenesis. Emerging evidence supports a link between broad-spectrum antibiotic use and CRC. We evaluated the associations between oral broad-spectrum antibiotic use and risk of eoCRC. Methods: We conducted a nested case-control study within Kaiser Permanente Southern California (KPSC). Cases were persons aged 15-49 years with invasive colorectal adenocarcinoma diagnosis between 2009-2021; controls were matched at 10:1 ratio on age, sex at birth, and length of KPSC membership. Those with less than 15 years of prior membership at diagnosis date or controls’ index date were excluded to allow evaluation of exposure up to 15 years prior. We extracted all study data, including use of antibiotics by drug type and days of prescriptions, from KSPC’s electronic medical records. Conditional logistic regression was used to evaluate antibiotic use from three etiologic periods: 10-15, 5-10, and 2-5 years prior to diagnosis/index date, adjusting for potential confounders (narrow-spectrum antibiotics use, clinical and lifestyle risk factors, race/ethnicity, body mass index) with a crude p-value < 0.10. Analyses were conducted overall and separately for colon cancer. Results: A total of 310 cases (mean age at diagnosis 44.5 years, 52% female, 33% non-Hispanic White) and 2,976 controls were included. In the 10-15 years prior to diagnosis/index date, 65% of cases and 62% of controls used broad-spectrum antibiotics. Broad-spectrum antibiotic use was not associated with eoCRC overall [OR = 1.15 (95% CI: 0.88-1.49)]. An increased risk was suggested for > 3 months of cumulative use: OR = 1.07 (0.81-1.42) for ≤1 month; 1.26 (0.87-1.84) for 1-3 months; and 1.59 (0.95-2.65) for > 3 months. The association between exposure and colon adenocarcinoma was: OR = 1.26 (0.91-1.72) for any use; OR = 1.17 (0.83-1.64) for ≤1 month; and OR = 1.50 (0.99-2.27) for > 1 month. No association was observed between broad-spectrum antibiotic use within 5-9.9 years or 2-4.9 years prior to diagnosis and risk of eoCRC overall or for the colon site. Conclusions: Our findings suggest a possible association between cumulative longer-term use of broad-spectrum antibiotics and increased risk of eoCRC. The etiologic window for assessing antibiotic exposure appears to be relevant. Larger studies with long-term follow-up are needed to confirm these findings.
Socioeconomic status and fertility counseling in patients with early onset colorectal cancer.
Authors: Littman Dalia , Peng Chengwei , Masri Lena , Sherman Scott , Makarov Danil V. , Becker Daniel Jacob 
Published: June 2024

e15654 Background: The incidence of early onset colorectal cancer (EOCRC) has increased over the past several decades, with a corresponding need to counsel younger patients about options for fertility counseling. The characteristics of patients at risk for going without fertility counseling are unknown. Methods: We conducted a single site retrospective review of all patients diagnosed with colorectal cancer between 2012 and 2019 who were men age 55 or younger or women age 50 or younger. Clinical data and documentation of fertility counseling were extracted from the electronic medical record by explicit chart review. Median household income (MHI) by zip code was gathered from census data and assigned to each patient based on home address. Results: 194 subjects were identified, of whom 69% had colon cancer and 31% had rectal cancer. 61% were male with average age 44 and 39% were female with average age 42. 55% were White, 11% were Black, 14% were Asian, and 10% were Hispanic. 13% had stage II disease, 44% had stage III disease and 40% had stage IV disease. 15.5% had documented fertility counseling, of whom 43% were male and 57% were female. In univariate analysis, age less than 40 years old, female sex, curative intent treatment, and home address in areas of higher MHI were associated with higher rates of fertility counseling. Race, tumor type, stage of disease, and year of diagnosis were not associated with differences in rates of fertility counseling. Conclusions: We found low overall rates of fertility counseling in patients with EOCRC, and consistent with prior analyses, lower counseling of men and those over age 40. We found that patients who live in areas of relative poverty were less likely to receive fertility counseling. Limited fertility counseling and high out-of-pocket costs of fertility preservation may combine to deny vulnerable patients an essential service. Given the increasing diagnosis of EOCRC, efforts are needed to increase the rates of fertility counseling both systemically and equitably. [Table: see text]
Effect on cardiovascular outcome of sodium-glucose co-transporter-2 (SGLT2) inhibitors among patients with cancer treated with anthracycline: A systematic review and meta-analysis.
Authors: Wannaphut Chalothorn , Wattanachayakul Phuuwadith , Saowapa Sakditad , Ponvilawan Ben , Tanariyakul Manasawee , Kewcharoen Jakrin , Yingchoncharoen Pitchaporn , Aiumtrakul Noppawit , Acoba Jared David 
Published: June 2024

e24001 Background: Sodium-glucose-co-transporter-2 (SGLT2) inhibitors have shown benefit in reducing cardiovascular outcomes in diabetes patients. Anthracycline therapy is associated with a risk of cardiomyopathy. However, the impact of SGLT2 inhibitors in the prevention of cardiomyopathy and heart failure in cancer patients undergoing anthracycline treatment remains unclear. Thus, we conducted a systematic review and meta-analysis to explore the effect of the prevention of cardiovascular outcomes in patients with cancer and diabetes who had received anthracycline therapy. Methods: We systematically reviewed Medline and EMBASE databases from inception to January 2024 for studies focusing on cancer patients with a history of anthracycline therapy. Eligible studies had to report relative risk (RR) with 95% confidence intervals for the clinical endpoints of mortality outcomes and the risk of HF exacerbation, comparing cohorts with and without SGLT2 inhibitor use. Results: Our study included 4 retrospective cohort studies in the meta-analysis (n = 6,708, 24% received SGLT2). There was significantly lower all-cause mortality in the SGLT2 inhibitors group (pooled RR of 0.52, 95% CI 0.35-0.77, I2 64%). However, there were no differences in the risk of heart failure exacerbation (pooled RR of 0.67, 95% CI 0.39-1.14, I2 17%). Conclusions: Our study found that anthracycline-treated cancer patients using SGLT2 inhibitors experienced lower all-cause mortality compared to the control group. A randomized clinical trial is necessary to further elucidate these findings.
Cardiomyopathy among recipients of immune checkpoint inhibitor therapy: A prospective study.
Authors: Zheng Haoyi , Granville Matthew J. , Miraglia Genie , Okin Emily , Weber Jonathan , Solito Stephanie , Jacob-Perez Sherly , Chung Su Yun , Roy Rajasree , Trotta Christina , Patel Dilip , Shlofmitz Richard , Cao Jane , Khalique Omar K. , Ali Ziad , Parikh Roosha , Jermyn Rita , Haag Elizabeth , Mehrotra Bhoomi , Mahmood Syed S. 
Published: June 2024

e24025 Background: Patients treated with immune checkpoint inhibitors (ICI) may develop cardiomyopathy, but data are limited on the rate of cardiomyopathy incidence. The aim of this study was to assess the occurrence of cardiomyopathy among ICI recipients. Methods: In this prospective surveillance study, echocardiograms and EKG were performed at baseline, and quarterly during the first year of ICI therapy. New or worsening cardiomyopathy was defined as left ventricular ejection fraction (EF) decline of > 10% from baseline to < 50%. B-type natriuretic peptide (BNP) and troponin were assessed weekly during the first three weeks of ICI therapy. Subsequent troponin for myocarditis assessment was tested as needed per treating oncology team. Results: A total of 23 patients were enrolled with mean age 73±10 years, 35% female, 74% Caucasian, and body mass index 31±7 kg/m2. Cardiovascular risk factors included hypertension (86%), diabetes mellitus (29%), myocardial infarction (19%) and smoking (10%), and prior radiation treatment (30%). Malignancies included lung cancer (50%), renal cell carcinoma (14%), and Merkel cell carcinoma or urothelial carcinoma (9% each). ICI regimen included pembrolizumab (48%), nivolumab (43%), and ipilimumab or atezolizumab (4% each). There was no change in weekly troponin or BNP, or quarterly QRS duration on EKG, and no myocarditis cases were observed. Between baseline and at 1-year since ICI therapy initiation, there was no change in QRS duration on EKG, as well as no change in median LVEF (59% [IQR 46-67] vs 61% [IQR 58-65], p = 0.48), or global longitudinal strain (18% [IQR 15-20]) vs 19% [IQR 18-21], p = 0.11). New cardiomyopathy occurred in 1 (4%) patient at 3 months following ICI initiation with LVEF drop from 53% to 38% and without troponin elevation to suggest myocarditis, corresponding to an incidence rate of 43.5 cases per 1000 person-years of observation. Conclusions: In this prospective surveillance study, new cardiomyopathy was observed after ICI treatment, although the incidence was low. Larger studies are needed to confirm these findings.
Resident physicians’ knowledge, attitudes, and practices on advance care planning for patients with advanced cancer in a national university hospital in the Philippines.
Authors: Ting Frederic Ivan Leong , Estreller Sachiko Solis , Pilapil John Christopher Agsalud , Real Irisyl Orolfo , Dee Edward Christopher Christopher 
Published: June 2024

e24037 Background: Advance Care Planning (ACP) is part of palliative care, an approach that improves the quality of life of patients and their families in the context of life-threatening illness, through the prevention and relief of suffering by means of early identification, assessment, and treatment of common problems associated with end-of-life care. Little is known about ACP and the utilization of advance directives in the Philippines, a country of 110 million people. The study aimed to explore the knowledge, attitudes, and practices of resident physicians in a national university hospital in the Philippines regarding ACP for patients with advanced cancer. Methods: Using a cross-sectional design involving resident physicians, an online survey with a self-administered questionnaire was distributed and answered by a total of 202 respondents. Results: Results show that a significant proportion of doctors: (1) view palliative and hospice medicine to be the same and without differences, (2) are comfortable with discussing ACP and prognosis of medical conditions with patients and their families, but (3) do not regularly initiate or offer ACP to them, (4) identify a lack of time, fear of imparting emotional distress to patients and their families, and personal discomfort as barriers to conducting ACP, and (5) have had no formal training for ACP but are willing to undergo such formation, given the opportunity. Conclusions: This study highlights the continuing need to bridge and unite knowledge, attitude, and practices pertaining to ACP among physicians. Further studies should be undertaken to device a proper training program and better explore the complexities of end-of-life care as it is experienced by Filipino patients with advanced cancer.
Testosterone replacement therapy (TRT) in patients with locoregional prostate cancer (LPC) treated with prior androgen deprivation therapy (ADT): A single center review.
Authors: Aglan Mostafa , Khadke Sumanth , Connell Brendan 
Published: June 2024

e24045 Background: In LPC, ADT may be combined with radiation therapy (RT) for 4-24 months. Post-ADT, a significant proportion of men experience prolonged hypogonadism. TRT can alleviate symptoms and improve metabolic outcomes. Contrary to longstanding concerns, there is no substantial evidence of increased prostate cancer recurrence in patients (pts) treated with single modalities (surgery or RT). However, sparse data ( < 100 cases published to our knowledge) exist regarding recurrence risk of LPC with TRT after prior ADT, where baseline T levels may fall below the androgen receptor saturation point. Methods: We retrospectively abstracted clinical data from hospital records of men with stage I – IVA PC, treated with prior concurrent ADT and RT and subsequently received TRT between January 2014 and September 2023. Extracted data included demographics, cancer diagnosis/staging, ADT/TRT treatment details and PSA and clinical outcomes. The co-primary endpoints were change in PSA and incidence of PC recurrence. Results: 21 pts met criteria. Median age was 77. ISUP Grade Groups (GG) included: GG1: 2, GG2: 2, GG3: 8, GG4: 2, and GG5: 7. AJCC 8th ed. stages were: I: 2, II: 7, III: 7, IV-A: 5. The median duration of prior ADT was 8 months (IQR 5 – 17) and the median interval from RT to TRT was 19 months (IQR: 12 – 44). Prior to TRT, the median testosterone level was 30.5 ng/dL (IQR: 17-76). TRT formulations included: injection: 6, oral: 4, topical: 13. The median follow-up period from the start of TRT was 13 months, and the median duration on TRT was 10 months (IQR: 5-22). TRT was ongoing in 15 (71.4%) pts and discontinued in 6 (28.6%). Reasons for discontinuation included testosterone recovery (1), hospice (not PC related) (2), no perceived benefit (2), MD concern for PSA rise (1). After TRT, the median testosterone level was 336 ng/dL (IQR: 207-462). Median PSA pre- and post-TRT were undetectable and 0.08 ng/dL, respectively. None of the subjects experienced PC recurrence or PC-specific mortality. One pt showed PSA bounce without recurrence. Median BMI was unchanged before (28.3 kg/m2) and after (27.7 kg/m2) TRT (p = 0.48). Due to the nature of the study, quality of life measures and metabolic parameters could not be systematically abstracted. Conclusions: In men with LPC who remained hypogonadal long-term after prior ADT and RT, we found that TRT was not associated with a significant rise in median PSA and no cases of PC recurrence were documented. This included many with a history of very high-risk cancers (eg. GG ≥ 4, Stage ≥ III). This study adds to the sparse existing literature in this clinical setting and together they support the case for a prospective trial utilizing TRT in patients who remain hypogonadal after ADT and radiation.
Implementation of a palliative care service in a tertiary hospital in a developing country: Methods, strategies and results.
Authors: Emerick Mendes Cecilia , Chimeli Daniela , Albuquerque Merian , Ferreira Tamina , Carvalho Simone , Alves Ribeiro Carolina , Ananda Gomes Sarah Ananda 
Published: June 2024

e24056 Background: In Rio de Janeiro, only 11 palliative care facilities exist, creating challenges in meeting the complex needs of patients with metastatic cancer. Our study aims to implement a palliative care service within an existing oncology practice. This approach holds promise as a model that could guide similar practices in low- and middle-income countries, offering a blueprint for the implementation of palliative care services on a broader scale. Methods: This descriptive study spans from February to December 2023, involving the monitoring of 176 patients. Eligible patients met criteria such as a FAST scale for dementia syndrome ≥ 7A, stage IV disease, ranking 5 stroke, terminal organic failure, uncontrolled symptoms, or requiring end-of-life care. The PC team, denoted as “Continued Care”, comprises a medical leader, 3 routine doctors, and 1 nurse. Activities undertaken by the team encompass consults requested by internal medicine and intensive care unit (ICU) teams, outpatient care, continuous education, and daily monitoring of patients with advance care plan (ACP). Results: Among 176 patients initially enrolled, outcomes were completed for 171 patients. Remarkably, 80% of those receiving PC assistance had an ACP in place, with 78% opting for exclusive non-invasive support. The overall death rate was 38%. Notably, among patients enrolled in the PC program, the ICU death rate was 31%. Conclusions: Institutional PC policies associated with the integration of a dedicated team into the hospital's routine, and investments in disseminating knowledge about irreversible illness processes and comfort strategies, emerge as a pivotal component in establishing a comprehensive and integrated model of PC services. This approach appears to surpass the effectiveness of traditional consult or sectorized model, emphasizing the importance of an institutionalized and holistic framework for delivering quality PC.