bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of protein energy malnutrition on hospitalized patients with lung cancer: A United States population-based cohort study.
Authors: Arya Yajur , Syal Arshi , Wattanachayakul Phuuwadith , Obomanu Elvis , Lara Joao Manoel da Silveira , Casipit Bruce Adrian , Leighton John Charles , Dourado Claudia M. 
Published: June 2024

11160 Background: Lung cancer is the leading cause of cancer related deaths in the United States. Patients with advanced lung cancer tend to have varying degrees of protein energy malnutrition (PEM), due to multiple reasons including cancer related cachexia, sarcopenia, and adverse effect of chemotherapy. However, the impact of PEM on clinical outcomes in this subgroup needs further exploration. Methods: We utilized the 2020 National Inpatient Sample (NIS) Database in conducting this retrospective cohort study. We identified patients with lung cancer and PEM using appropriate ICD-10 diagnostic codes. We stratified patients with lung cancer based on the presence or absence of PEM. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p value of <0.05 was considered statistically significant. The aim of this study was to investigate the impact of PEM on in-hospital mortality, hospital length of stay (LOS), and total hospitalization charge among hospitalized patients with lung cancer. Results: We identified a total of 92425 hospitalized patients with lung cancer, of which 10.53% (9739/92425) had comorbid PEM. The overall in-hospital mortality among patients with lung cancer was 5.79% (5360/92425). Among those with concomitant PEM, the mortality rate was significantly higher at 13.13% (1279/9739, p<0.001). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, PEM was found to be an independent predictor of increased in-hospital mortality (adjusted OR 2.11; 95% (confidence interval [CI] 1.77-2.51; p<0.001), longer LOS (coefficient 3.02; CI 2.62-3.42; p<0.001), and higher total hospitalization charge (coefficient $22105; CI $13423- $30786; p<0.001). Conclusions: Our analysis demonstrated that PEM was widely prevalent in hospitalized patients with lung cancer and associated with worse outcomes. Efforts should be made to promote nutritional assessment and screening mechanisms with the aim to initiate early nutritional support as indicated. Further prospective studies are warranted to better understand these associations and guide management.
Time to treatment initiation: An assessment of trends in delays in patients with lung cancer across Missouri.
Authors: Chelapareddy Lakshmi Ramya , Beheshti Mohammad , Naha Kushal , Zachary Iris 
Published: June 2024

11186 Background: Lung cancer is a major health challenge globally. Missouri's incidence rate of 68.1% exceeds the national rate of 54.0% indicating a significant disease burden. It is the 2nd most common malignancy in men and women in the state. Timely treatment can significantly improve while delays can worsen outcomes. The Institute of Medicine strongly recommends efforts promoting timely care in lung cancer. The RAND Cooperation suggests treatment should begin within 6 weeks after diagnosis. These priorities align with the Healthy People 2030 Initiative which aims to reduce lung cancer incidence and mortality through enhanced screening and early treatment. The U.S. National Committee on Health Care identified a goal of 60% of lung cancer patients receiving treatment within 30-days of diagnosis. Our primary objective was to assess delays in treatment initiation post-diagnosis and to investigate Missouri’s adherence to treatment delay guidelines in lung cancer patients. Methods: Study population included adults (age>18) with a diagnosis of Lung Cancer, identified using ICD-10 codes C50.0-C50.9. Records were retrieved from the Missouri Cancer Registry and Research Center database for the years 2012-2022. Data for 2022 had a completion rate of 90%, all others had at least 95% completeness. We used the RAND guidelines 42-day treatment delay rule and the Missouri Cancer Action Plan's (MCAP) 30 day treatment delay metric as our benchmarks. Treatment delay was determined by subtracting the Date of Initial Diagnosis from the Date of First Course Treatment. Records with missing or incomplete dates were excluded. Data processing and analyses were performed using Python 3.11. Results: Of the 68,293 adult lung cancer patients in the database, 7,882 were excluded due to missing or incomplete data. Among the eligible 60,411 patients, 89.5% were Caucasian, median age was 69 (range 18-105), gender distribution was nearly equal with males accounting for 51.3% of the total. Average time from diagnosis to treatment was 36.8 days, with a median of 27 days. About 31.2% of patients had a gap over 42 days from diagnosis to first treatment. This delay has risen from 26.3% in 2012 to 42.6% in 2022, marking a 16.3% increase. In terms of adherence to the MCAP’s 30 day treatment delay metric, 45.6% of patients experienced more than a 30-day gap between diagnosis and treatment. The trend shows an increase in delays, from 40.4% in 2012 to 58.1% in 2022, reflecting a 17.7% rise. Conclusions: Despite the declining incidence rate of lung cancer in Missouri over the years, our analysis revealed a surprising increase in treatment initiation delays over the years. The average time from diagnosis to treatment and the percentage of patients experiencing delays exceed the RAND guideline and the MCAP's treatment delay metric and with a rising trend from 2012 to 2022. Further analysis into factors causing delay in treatment initiation is needed and being planned.
The utility of procalcitonin in febrile neutropenia.
Authors: Nilles Jonathan , Shonka Nicole A. 
Published: June 2024

12040 Background: The utility of procalcitonin (PCT) in febrile neutropenia (FN) in oncology patients on active therapy has not been well validated. FN constitutes a critical oncologic emergency, often characterized by subtle manifestations of infection, and timely diagnosis and treatment is vital. Although a potential harbinger of dangerous infection, FN can also occur without an identifiable infection, in which case hospitalization and antibiotics may be unnecessary. PCT, an amino acid, is elevated specifically during bacterial infections in the non-cancer population and correlates with infection severity. Clinicians employ PCT levels as a diagnostic adjunct, discerning bacterial from viral infections and analyzing PCT changes to guide treatment decisions. We examined oncology patients presenting with FN to correlate PCT levels and trends with confirmed infections. Methods: We identified patients with neutropenic fever, cancer, and a PCT result seen at our institution from 12/1/2017-12/1/2022. Patients were determined to have a confirmed infection if they had a positive bacterial blood culture. Demographics and clinical characteristics were compared between infection status and induction chemotherapy or transplant status using a Wilcoxon Rank Sum test for continuous variables and a Chi-Square or Fisher’s Exact test for categorical variables. Baseline (at time of initial FN) and highest PCT levels were compared by patient and disease characteristics and proven infection using Wilcoxon Rank Sum test. Logistic regression was used to determine the association of log-transformed PCT (baseline and highest) with proven infection (yes/no) while adjusting for covariates. All tests were two-tailed with p< 0.05 considered statistically significant. Results: Of 365 patients, 61 (16.7%) had an identified infection. Median baseline and peak PCT of 1.26 and 1.51 ng/mL, respectively, were significantly greater for these patients as compared to those with negative cultures at 0.54 and 0.65 ng/mL, respectively (P= 0.01 and <0.01). For every unit increase in the log transformed baseline PCT, the odds of having a proven infection increased by 23%. There were no significant differences in patient or clinical characteristics between those with and without infection. Of those admitted for induction chemotherapy and transplant who developed FN, PCT at time of initial fever was higher at 0.97 vs 0.56 ng/mL (p=0.02). Interestingly, median baseline and median peak PCT differed between gender with females 0.51 and males 0.72 ng/mL (p=0.02) at baseline, and 0.63 vs 0.83 ng/mL (p=0.04), respectively, at peak. Conclusions: PCT levels in cancer patients with FN are significantly associated with culture positive infection. This data can help guide treatment and de-escalation of antibiotics in cancer patients admitted with FN. Further evaluation should be taken to determine how to best use PCT to determine the need for admission and antibiotic prescription.
Patients with a history of more than one cancer diagnosis: An opportunity to expand eligibility criteria?
Authors: Campos Luis T. , Peguero Julio Antonio , Koontz Michael Zach , Trotter Chardria , Svedman Christer , Paulson Joseph , Chung Wei-Yi , Tucker Valerie , McAneny Barbara L. , Campbell Fontaine Annette 
Published: June 2024

e23019 Background: Patients with a history of more than one cancer diagnosis are increasingly common due to improved cure rates in early-stage cancers, and a demographic shift towards an increasing proportion of elderly patients with cancer due to longer life expectancy. Having a prior cancer diagnosis is a common exclusion criteria in clinical trials but represents a large untapped pool of patients that could increase enrollment in trials. We assessed if there are differences in the clinical characteristics, NGS testing rates and the rate of actionable genomic alterations in patients with NSCLC with a history of at least one other cancer diagnosis. Methods: We analyzed patients with a NSCLC diagnosis and an appointment scheduled between Oct 23, 2023 and Jan 14, 2024 at three US community oncology sites. All patients were enrolled in the Kaleido Registry and descriptive statistical analyses were performed on curated data. Results: 221 patients were identified (110 male/111 female). Median age was 72 (range 37-95). 157 (72%) patients had NSCLC as their only cancer diagnosis and 67 (28%) had a history of other malignancy with a median time interval since the last cancer diagnosis of 78 months (interquartile range 28-141 months ). 49 patients had a history of 1 other cancer diagnosis and 18 patients had a history of 2 or more. The most common diagnoses were breast (n = 16, 7%), colon (n = 7, 3.2%), prostate (n = 7, 3.2%) and bladder (n = 4, 1.8%) cancers. There were no differences in median age (73 yrs, range 57-91 vs (72 yrs, range 37-95), or sex distribution (30/34 vs 80/77) between patients with multiple diagnoses vs those with only NSCLC. There was not enough power to detect a difference in the rates of NGS testing rates or actionable genomic alterations (EGFR/ALK/ROS1/KRAS/RET/MET/NTRK/BRAF/HER2) in the cohorts (51% vs 64%, respectively). Conclusions: One in four NSCLC patients had a history of other cancer diagnosis. There were no significant differences in baseline characteristics or actionable genomic alterations. The median interval since the last cancer diagnosis was more than 6 years and less than a third had less than 3 years. These findings indicate that a significant number of patients with prior cancer diagnoses may be suitable candidates for clinical trials as their risk of recurrence of prior disease is likely low given long follow-up in this cohort.
Is essential thrombocytosis associated with worse outcomes in patients with stroke? Results from 2016-2020 National Inpatient Sample study.
Authors: Kharel Himal , Bhandari Samikchhya Keshary , Kharel Zeni , Sanjeevi Aditya , Rao Aniket , Shah Purva , Orakzai Abdullah Ahmad , Eltaher Basant , Pokhrel Nishan Babu , Jamshed Saad 
Published: June 2024

e23060 Background: Essential thrombocythemia (ET) is a myeloproliferative neoplasm. Thrombosis is a major cause of morbidity and mortality in ET. It is unknown whether the morbidity and mortality of ischemic stroke in ET is different from that in non-ET patients. Similarly, the quantitative data regarding the use of platelet pheresis in this population is also unknown. This National Inpatient Sample (NIS) database study aims to answer these questions. Methods: A retrospective analysis of the NIS database from 2016 to 2020 was conducted using ICD-10 codes to identify hospitalizations with ischemic stroke. STATA version SE18.0 was used for statistical analysis. We used multivariate regression analysis to calculate the effects of ET on mortality and length of stay along with various other variables including age, gender, primary payer, household income, Charlson Comorbidity index, hospital bed size, hospital region, diabetes mellitus, heart failure, hypertension, coronary artery disease, smoking, hyperlipidemia, carotid artery stenosis, and atrial fibrillation. Results: There were 2,635,595 hospitalizations with primary diagnosis of ischemic stroke. Among these, 9604 patients had secondary diagnosis of ET. The mean age of ET patients with stroke was 67 years. 60.5% of patients were females. 40 (0.41%), 335 (3.48%) and 720 (7.49%) patients underwent plateletpheresis, thrombectomy, and thrombolysis respectively. Multivariate logistic regression showed that ET was not associated with increased mortality, but was associated with significantly increased length of stay with odds ratio (OR) of 0.95 [95% confidence interval (CI) = 0.73 to 1.23, p-value = 0.7) and 2.58 (95% CI = 2.12 to 3.04, p-value = 0.00) respectively. The effect of other pertinent variables are summarized in Table 1. Conclusions: Our analysis shows that stoke in ET was not associated with increased mortality. ET was associated with increased length of stay in patients with stroke. 0.41% of ET patients with stroke received platelet pheresis. Limitations of this study include failure of the multivariate model to account for all the variables, coding errors, and increased risk of bias due to retrospective nature of the data. [Table: see text]
Daily diary engagement among caregivers of patients undergoing hematopoietic stem cell transplant.
Authors: Poudel Ranjita , Yang Min-Jeong , Gore L. Robert , Washington Sierra , Jones Sarah , Brown Brad A. , Vinci Christine 
Published: June 2024

e23064 Background: Caregivers of allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients bear significant responsibilities involving commitment to be available 24/7 up to at least 100 days post-transplant to provide emotional and physical support to their patients. Caregiving for such an extended duration is associated with reduced quality of life, compromised psychological well-being, and dysregulated metabolic and immunological functioning. Ecological momentary assessment (EMA) may allow a better understanding of the dynamic day-to-day experiences of this unique population. However, no prior research on EMA exists in this population. This study reports on the feasibility of delivering EMAs in the form of a daily diary (DD) and how completion of the DD relates to the patient’s course of treatment and caregiver’s demographics among the caregivers of allo-HSCT caregivers. Results are part of an ongoing 3-arm randomized controlled trial (71% enrolled to date) of those individuals randomized to the usual care condition. Methods: Caregivers (n = 46) received DD prompts for 6 weeks during their patient’s active treatment phase: before transplant (week 1), transplant through discharge (weeks 2 and 3), after discharge (weeks 3 through 6). The DD included six affect items from the Positive and Negative Affect Schedule (stressed, overwhelmed, frustrated, drained, guilty, and hopeful), three state mindfulness items (attention, non-judgement, and decentering), and one item related to caregiver’s self-efficacy in patient care. Results: Among 46 caregivers (mean age = 55.8 [SD = 15.7], 74% female, 32% retired), the overall completion rate (CR = total number of prompts completed/total number of prompts received) was 65.5%, with 72% of participants completing > 50% and 22% of participants completing > 85% of the prompts. For the duration before transplant, the overall CR was 63.2%, with 66.7% of participants completing > 50%, and 33.3% completing > 85% of the prompts. For the duration between transplant through discharge, the overall CR was 65.57%, with 76% of participants completing > 50%, and 26% completing > 85% of the prompts. Similarly, for the duration after discharge, the overall CR was 65.14%, with 66.7% completing > 50%, and 28.9% completing > 85% of the prompts. DD completion was not related to the caregiver’s age, sex, or employment status ( ps > 0.1). Conclusions: The completion rate for the DD was very similar across the patient’s course of treatment, suggesting EMA completion is not excessively burdensome for caregivers potentially experiencing dynamic distress. Furthermore, EMA completion was not associated with age, sex, or employment status, indicating that all caregivers, regardless of demographics, were amenable to completing EMAs. Our findings suggest that delivering EMAs is feasible in this population. Clinical trial information: NCT05078229 .
Epidemiological analysis and overall survival of adrenal malignancies in a developing Middle Eastern country over 18 years.
Authors: Abdulelah Ahmed A , Abdulelah Zaid A. , Alhajahjeh Abdulrahman Ahmad , Saadeh Aseel , Al-Dqour Mohammad , Abdel-Razeq Hikmat 
Published: June 2024

e23067 Background: Adrenal cancer imposes a significant socioeconomic and health burden due to the resulting morbidity and mortality. Accordingly, assessment of the epidemiological characteristics of adrenal malignancies in the Middle East, where the epidemiology of adrenal malignancies is poorly evaluated, is of paramount importance in management tailoring and planning as it enables appropriate risk stratification, especially in limited resource countries. Methods: Extensive and thorough data on adrenal cancer for all individuals, both males and females, of various nationalities residing in Jordan who were diagnosed from 2000-2018 was retrieved from the Jordan Cancer Registry, the formal reporting institution for cancer epidemiology in Jordan with a total of 296 patients being included. Furthermore, comprehensive epidemiological analysis was performed with Kaplan-Meier analysis being performed to assess overall survival rates. Results: 296 patients with a mean age of 18.7 ± 22.6 years old and a male predominance of 55.4% were included in the analysis. The vast majority of the included patients were non-smokers (72.3%). Adrenal malignancy was found to be most commonly located in the left adrenal gland (41.6%), while only 7 patients (2.36%) had bilateral adrenal malignancies. 19.6% of the tumors were arising from the adrenal cortex while 70.9% of the patients had adrenal gland tumors with the origin being unknown at the time of reporting. A concerning 17.20% of the enrolled patients had poorly differentiated tumors, and 8 patients (2.70%) had undifferentiated malignancies. At the time of diagnosis, a staggering 51.0% of the patients had distant and systemic metastasis, while only 11.8% of the patients had localized malignancy. The overall 5-year survival rate was determined to be 66.8%. A statistically significant increase in the crude incidence of adrenal cancer in Jordan over 18 years was evident with a crude incidence estimated effect of 0.014 (p-value = 0.003). Conclusions: Despite that the 5-year survival is 66.8%, there is an alarmingly significant uptrend in the crude incidence of adrenal cancer in Jordan with the overwhelming majority presenting at an advanced stage, and thus the introduction of early interventions and advanced management is mandated to achieve better outcomes.
Site research infrastructure and institutional performance: A report from the Voting Body of the Children’s Oncology Group (COG).
Authors: McNall-Knapp Rene Y. , Kadan-Lottick Nina S. , Chang Eugenia , Maloney Kelly W. , Malogolowkin Marcio H. , Alonzo Todd Allen , Mascarenhas Leo 
Published: June 2024

e23113 Background: National Cancer Institute (NCI) sponsored cooperative group clinical research has led to significant improvements in outcomes for childhood cancer in the United States. COG is the world’s largest cooperative group, comprised of 218 institutions in good standing. There are no benchmark data of the necessary research infrastructure for successful participation in COG research. Objectives: 1) To ascertain the research personnel (RP) devoted to COG research at each member institution. 2) To compare available resources with institutional performance. Design. Methods: A REDCap® survey was designed and sent to all 218 COG institutional principal investigators (PI) with a 4-week window to complete the survey with scheduled reminders. Questions included number of and types of RP [clinical research associates (CRA), nurses, and regulatory]. To measure performance, we used the 2022 Institutional Report Card from COG that reports open trials and enrollments at each site. Sites were categorized into 4 groups based on self-reported new oncology patients diagnosed per year. We compared the number of RP to the a) number of studies open, b) enrollment on therapeutic and non-therapeutic studies. We ranked performance into quartiles by institution size. Results: 134 PIs (61%) answered some or all questions on the survey. All institutional sizes were well-represented. Total number of RP varied dramatically, even among institutions of similar size, with median number 3 RP, range 0.9-28.5. Comparing the number of open studies to regulatory personnel at site, those institutions in the top quartile for each group (except very smallest) had a minimum of 91 studies open and had at least 1 FTE for regulatory, while those in the lowest quartiles (10-67 studies open) had < 1 FTE. Total number of RP were similarly correlated with the number of enrollments, with mean of 12.5 and median 15 enrollments for each RP. Conclusions: Sites successful at opening COG studies and enrolling patients had more research personnel. We show to perform in the top quartiles, there should be at least 1 FTE dedicated to regulatory issues and another 1 FTE for every 12-15 enrolled subjects. [Table: see text]