bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-effectiveness of short-course radiotherapy versus long-course chemoradiation in organ preservation for locally advanced rectal cancer.
Authors: Dornisch Anna , Cui Christina , Luo William Yu , Sherer Michael Vincent , Murphy James Don 
Published: June 2024

11089 Background: Short-course radiation therapy (SCRT) has previously been found to be cost-effective compared to long-course chemoradiation (LCRT) for patients with locally advanced rectal cancer undergoing operative management. However, non-operative management protocols have recently become a standard treatment option for patients diagnosed with locally advanced rectal cancer achieving a complete clinical response after total neoadjuvant therapy (TNT) as surgery has significant impacts on quality of life. Recent data suggests higher rates of local regrowth and a correspondingly lower rate of organ preservation with SCRT-TNT compared to LCRT-TNT. With this study, we evaluated the cost-effectiveness of SCRT versus LCRT in the setting of non-operative management for locally advanced rectal cancer. Methods: We built a microsimulation model to simulate 5-year outcomes for 1 million hypothetical patients aged 65 years with locally advanced rectal cancer treated with TNT including either SCRT or LCRT. Patients achieving a complete clinical response with TNT opted for a non-operative management approach, undergoing surgery only with subsequent local progression. Patients not achieving a complete clinical response went directly to surgery. The model incorporated costs, quality of life (measured by health utility), and probabilities of disease progression and death. We extracted probabilities of disease progression and death and health utilities from published literature. We assessed costs from the healthcare payer perspective. We measured cost-effectiveness with incremental cost-effectiveness ratio (ICER), with ICERs under $100,000 per quality-adjusted life-year (QALY) considered cost-effective. One way and probabilistic sensitivity analyses were used to test model uncertainty. Results: We found that compared to SCRT, LCRT increased overall cost by $10,457 and improved effectiveness by 0.16 QALYs resulting in an ICER of $67,200/QALY. The model was most sensitive to assumptions about risks of local recurrence in the non-operative setting, the health utility of non-operative management, and the costs of LCRT and SCRT. The model was not sensitive to assumptions about costs of diagnostic evaluation (i.e. flexible sigmoidoscopy) and probability of distant recurrence. Probabilistic sensitivity analysis demonstrated that LCRT was cost-effective in 91% of iterations. Conclusions: Long-course chemoradiation could represent a cost-effective strategy compared with short-course radiotherapy in the non-operative management of patients with locally advanced rectal cancer. The ongoing ACO/ARO/AIO-18.1 trial testing the hypothesis that LCRT-TNT will increase organ preservation rates relative to SCRT-TNT will help confirm these findings.
Systemic anti-cancer therapy and cost at end of life: A SEER Medicare analysis.
Authors: Adelson Kerin B. , Cheng Lee , Huang Yu-Ting , Niu Jiangong , Zhao Hui , Nortje Nico , Xiang Jenny Jing , Giordano Sharon H. , Canavan Maureen 
Published: June 2024

11092 Background: Systemic anticancer therapy (SACT) administered near the end of life (EOL) is associated with higher costs, driven by pharmaceuticals and associated acute care use that occurs when patients continue treatment in lieu of transition to hospice. Since 2015 overall rates of systemic therapy at the EOL have remained stable, while some chemotherapy has been replaced by costly immunotherapy. It is not known whether immunotherapy is associated with the same impact on total cost of care (TCOC) as chemotherapy. We evaluated the relationship between type of SACT vs no SACT within 30 days of death on categories of cost. Methods: We identified patients from the SEER-Medicare database diagnosed between 2005 and 2019 with solid tumors (ST) and liquid tumors (LT) who died from 2015-2020. We assessed differences in Medicare cost within 30 days of death by subtype of SACT: combination chemo-immunotherapy (CI), immunotherapy only (IO), chemotherapy only (CO) and no SACT. Dependent variables were TCOC (including all Medicare claims), as well as cost of drugs, hospitalizations, emergency department (ED), and hospice normalized and adjusted for inflation. Results: 6.2% (27,317/440,349) of ST decedents and 12.7% (7,544/59,449) LT decedents received SACT at EOL. See table. Among ST patients who received SACT, the mean TCOC was $26,282 (standard deviation (SD) $26,700) and was highest among patients receiving CI, $27,973 (SD: $26,285) vs. $17,642 (SD: $29,798) for patients without SACT ( p <.001). Among LT patients who received SACT, the mean TCOC was $26,282 (SD $26,700) and was highest among CI patients $33,632 (SD: $26,283) vs. $24,689 (SD: $39,735) for patients with no SACT ( p<.001). We observed higher cost for drugs, hospitalizations (except for LT patients receiving CI vs. no SACT), ED and lower hospice costs for patients receiving each SACT subgroup compared with no SACT. All results except those noted in table were significant (p <.001). Conclusions: Receipt of SACT within 30 days of death was associated with significantly higher Medicare costs. Higher TCOC in those who received SACT is only partially explained by drug costs; most acute care costs were also significantly higher among patients who received any type of SACT including CI, IO, CO than among those who did not. [Table: see text]
Enhancing the patient journey to clinical trial enrollment with navigation to optimize accrual: A pilot study for a pragmatic multicentre, stepped wedge, cluster randomized controlled trial (The CTN Pilot Trial).
Authors: Akingbade Emmanuel , Fatima Rija , Delisle Megan , Abdel-Nabi Rhonda , Hossami Mahmoud , Touma Kayla , Nassar Renee , Sharma Depen , Luginaah Anthony , Hamm Caroline M. 
Published: June 2024

11093 Background: Clinical trials are essential to the advancement of clinical therapies, yet accrual rates remain disappointing. Multiple challenges lead to less than 5% of cancer patients enrolled onto clinical trials. The Clinical Trials Navigator (CTN) program was established to assist patients and health care professionals identify appropriate clinical trials for patients. Methods: Between March 2019 to January 2024, a novel navigator-assisted clinical trials search program was offered to Canadian patients. Three non-medical navigators were trained to receive referrals, review medical information, and search five different clinical trial search engines. Eligibility criteria was scrutinized. A second review of the clinical trial list was conducted by two physicians. The final curated list of clinical trials was provided to patients and their oncologist. Results: A total of 373 patients were referred to the CTN program during the study period. A unique clinical trial search was performed for each patient yielding a median of only one potentially eligible trial per patient. Clinical trial enrolment occurred in 3.2% of patients in our database which translates to a 19% rate of successful enrolment of those referred to a trial by the CTN. Most patients (78%) were referred to clinical trial sites that conducted more than 100 clinical trials at any time. Compared to the Canadian cancer statistics, lung, lymphoma, pancreatic and brain cancers were overrepresented in referrals to the CTN program while prostate cancer was underrepresented. Type of cancer played a significant role in the likelihood of a successful referral (p < 0.01). Lung cancer was the most frequently reported cancer that resulted in referrals and breast cancer showed a lower frequency of referrals. The cancer type, stage and number of lines of prior therapy were not significantly associated with the patient enrollment onto a clinical trial. An increase in survival of referred patients from last analysis from 3.0 months to 5.3 months. Conclusions: The CTN program is a successful tool to identify clinical trials for cancer patients and can improve clinical trial accrual, as almost one fifth of patients (19%) who were referred to a clinical trial were enrolled. Ongoing iterative changes to the program to improve these metrics are underway and efforts to improve implementation of the CTN program across Canada are ongoing.
Implementation and preliminary efficacy of a risk stratification system +/- patient-reported outcomes monitoring for patients with hospital-diagnosed advanced lung cancer.
Authors: Ray Emily Miller , Gentry Amanda , Ledenyi Madeleine , Elston Lafata Jennifer Elston , Sanoff Hanna Kelly , Mody Gita N 
Published: June 2024

11095 Background: Risk stratification systems may improve quality of care for patients with advanced lung cancer (ALC) by identifying those at high risk of rehospitalization and directing them to supportive care. The purpose of this study was to evaluate the implementation and preliminary efficacy of a risk-based system, with/without electronic patient-reported outcome (ePRO) symptom monitoring, to trigger supportive care for patients with hospital-diagnosed ALC. Methods: In this single-site, non-randomized, pragmatic study, patients in an academic center with hospital-diagnosed ALC were stratified to low or high risk using an established tool. High-risk patients were referred to two-pronged supportive care: patient navigation and outpatient palliative care. Eligible patients were recruited for 3 months of ePRO symptom monitoring coupled with provider alerts. Healthcare utilization was assessed at 90 days post-discharge. Program feasibility and acceptability were assessed using percent of eligible supportive care referrals made and completed, enrollment rates in ePROs, ePRO completion, and notifications to providers of concerning symptoms. Preliminary efficacy was defined as percentage of concerning ePRO symptoms resulting in new clinical action and 90-day readmissions. Results: At the time of interim analysis, 49 patients had been assessed with 48/49 (98%) identified as high risk. Patients had a mean age of 66 years, and were non-Hispanic, 51% male, and 22% Black. Patient navigation referral (92%) and completion (88%) was high. Palliative care referral (89%) and completion (45%) was lower. 14/39 (36%) of eligible patients enrolled in ePRO symptom monitoring, with competing priorities or feeling overwhelmed as the primary reasons for non-participation. Patient-level ePRO completion ranged from 0-100% (mean 53%). Nearly all (97%) concerning symptoms were reported to the clinical team; 27% of these resulted in new clinical action. By 90 days, 16/37 (43%) had hospital readmissions. Conclusions: Patient navigation was feasible and acceptable in patients with hospital-diagnosed ALC. However, there are ongoing barriers to implementation of post-hospitalization ePRO symptom monitoring and palliative care. Additional evaluation is needed to understand the barriers and facilitators and to measure the impact of navigation on patient outcomes. Since nearly all patients met high-risk criteria, future programs will eliminate risk stratification and target all patients with hospital-diagnosed ALC. Clinical trial information: NCT05722847 . [Table: see text]
Relationship between cognitive and emotional domains of prognostic awareness with quality of life and psychological distress in patients with advanced cancer.
Authors: Greydanus Claire , Lavoie Mitchell W. , Temel Jennifer S. , Greer Joseph A. , Park Elyse R. , Jackson Vicki , El-Jawahri Areej , Amonoo Hermioni L. 
Published: June 2024

11106 Background: Prognostic awareness, a measure of patients’ cognitive and emotional perception of their illness and prognosis, allows individuals to align their medical decision-making with their goals and values. Prior studies have shown mixed findings regarding the relationship between prognostic awareness with better quality of life (QOL) and less psychological distress in patients with advanced cancer. However, studies have not investigated whether it is the cognitive or the emotional aspects of patients’ awareness of their prognosis that are associated with QOL and psychological distress in patients with advanced cancer. Methods: We conducted a cross-sectional study of patients with metastatic solid malignancies not being treated for curative intent at a single academic center from 11/2019-6/2022. We used the Prognostic Awareness Questionnaire (PAIS) to measure the cognitive (i.e., the capacity to understand one’s prognosis characterized by the accurate perception that a cancer is curable or not) and emotional coping with prognosis (i.e., the capacity to emotionally process prognostic uncertainty and terminal prognosis). We used the Functional Assessment of Cancer Therapy-General (FACT-G), Hospital Anxiety and Depression scale (HADS), and the Peace, Equanimity and Acceptance in the Cancer Experience (PEACE) scale to measure, QOL, psychological distress, and acceptance of illness, respectively. We used multivariate regression models controlling for age, gender, and cancer type to assess the relationship between the cognitive and emotional prognostic awareness domains and patient-reported outcomes. Results: Overall, 632 participants (age 65 years (SD=11.3), 51% female, 76% married or living with a partner) were enrolled in the study. In multivariate models, higher cognitive understanding of prognosis was not associated with QOL (b=-2.134; p=0.069), psychological distress (i.e., anxiety: b=0.331; p=0.232 and depression; b=0.233; p=0.368), or peaceful acceptance of terminal illness (b=-0.045; p=0.838). However, emotional coping of prognosis was associated with better QOL (b=1.981; p<0.001), less anxiety (b=-0.516; p<0.001) and depression (b=-0.370; p<0.001) symptoms, and more peaceful acceptance of terminal illness (b=0.438; p<0.001). Conclusions: Patients’ emotional coping with their prognosis, rather than their cognitive understanding of their terminal prognosis, was associated with their QOL, psychological distress, and acceptance of their illness. These findings underscore the importance of examining prognostic awareness and its association with patient-reported outcomes by domains. We also highlight the need to develop supportive care interventions to promote effective coping strategies for patients after prognostic disclosure.
Impact of transitions of care nurse navigation on post-discharge follow-up.
Authors: Lo Celina , Miller Jackie , Csik Valerie Pracilio 
Published: June 2024

11126 Background: Poor discharge communication is among the primary causes of readmissions and many patients are lost to follow-up (F/U) post-discharge (PD). For newly diagnosed (DX) cancer patients, the coordination of care from inpatient (IP) to outpatient (OP) follow-up is critical. At the Sidney Kimmel Cancer Center in Philadelphia, we saw a no show (NS) rate of 6.6% for PD F/U appointments (Oct-Dec 2022) resulting from deficient communication. To improve the IP to OP transition for cancer patients, a Transition of Care Nurse Navigator (ToC NN) pilot was initiated to support patients discharged from Thomas Jefferson University Hospital (TJUH). The goal was to complete 80% of PD visits and reduce the NS rate by 20% by 12/31/23. Methods: The target population are patients that are newly DX solid tumor patients that will be discharged to home/rehab and need an OP Medical Oncology appointment. Through communication with hospitalists, IP Fellows/Residents, and/or Attendings, the ToC NN is referred eligible patients. The ToC NN visits patients during hospitalization or follows-up post-discharge to assess Health Related Social Needs and distress. PD F/U appointments are communicated during the initial contact along with information about the OP resources available and referrals are made based on patient interest/needs to social work, nutrition, or supportive medicine. All communication is documented by the EMR and the oncology care team is notified. The ToC NN follows up with the patient/patient’s family member 48-72 hours after hospital discharge to check in and do a symptom management call. Additional F/U calls are made as needed. The ToC NN serves as the patient’s point of contact (POC) from discharge to OP new patient visit (NPV) appointment. Results: The pilot exceeded the 80% goal of completion of PD visits. It revealed a 41.4% increase of PD NPV completion and a 21.9% decrease of NS rate from the 2022 to 2023 data. Conclusions: The ToC NN services showed significant impact in supporting patients transition from IP to OP. Our findings confirm having a contact after hospital discharge increases the completion of PD visits due to effective communication and support. [Table: see text]
Mutated KRASas a promising target in pancreas cancer: PURPLE registry data to inform real-world incidence and prognostic significance and to aid trial recruitment.
Authors: Lee Belinda , Tian Eric , Croagh Daniel , Harris Marion , Thomson Benjamin , Michael Michael , Loveday Benjamin , McLachlan Sue-Anne , Knowles Brett , Shapiro Jeremy David , Wong Rachel , Fox Adrian , Jennens Ross , Yong Tuck , Hodgson Russell , Houli Nezor , Ananda Sumitra , Lipton Larissa Rachel , Mendis Shehara Ramyalini , Gibbs Peter 
Published: June 2024

11150 Background: With around 90% KRASmutation (mt) frequency, pancreatic ductal adenocarcinoma (PDAC) is considered the most RAS-addicted cancer. Despite guideline recommendations, genomic testing is not routine in all PDAC patients (pts) in Australia, due to unproven clinical impact. As more novel KRAS-direct therapeutics enter clinical trials, understanding the real-world frequency of individual mutations and prognostic significance, and facilitating trial recruitment are important goals, all of which can be supported by registry data. Methods: Data extracted from the PURPLE pancreatic cancer registry from 9 participating Australian cancer centres, between 2016-2022, was analysed to compare clinicopathological features, survival based on KRASmt status, and assess feasibility of the platform to identify and molecularly stratify patients for future clinical trials. Survival estimates were calculated using Kaplan-Meier curves and log-rank testing on SPSS (Macintosh v.29). Results: Of 721 PDAC routine care pts identified, next generation sequencing (NGS) was undertaken in 378/721 (52%). Median patient age was 68 years (range 52-83); 152 (40%) had resectable, 111 (29%) locally advanced and 115 (30%) metastatic disease. 57/378 (15%) were KRAS wildtype. Of 321 pts with a KRAS mt, codons 12,13, and 61 were the most common sites of mt, including G12D (45%), and G12V (30%), with lower frequencies of G12R (13%), Q61H (6%), G12A (3%), G12C (1%), and G13D (1%). Comparing KRAS wildtype to KRASmt pts, there was no difference in median age (68 vs 67, p=0.63), gender (male: 49% vs 60%, p=0.23), Charlson comorbidity index (p=0.30), or stage at first presentation (p=0.99). Overall KRAS wildtype pts were more likely to be ECOG PS 0 at diagnosis (p=0.01) and to receive at least 1 modality of treatment (p=0.004). For all pts, median overall survival (OS) in KRASwildtype versus KRAS mt pts was 29.0 months versus 19.7 months (p=0.007), and for the 115 metastatic pts 15.1 versus 10.4 months (p=0.28). Further analysis of the impact by disease stage and by individual RAS mt is underway. Conclusions: Registry based analysis informs understanding of KRAS mt status of PDAC in a community setting. Here, KRAS mt status was associated with worse OS outcomes, likely in part due to the association with ECOG PS and receiving less active treatment. With newer promising KRAS-targeted therapies becoming available in clinical trials, known RAS status will aid identification of trial candidates. The clinical utility of NGS and rationale for reflex testing in PDAC is increasing. Clinical Registry information (ACTRN12617001474347).
Therapy-related myeloid neoplasm risk score (TMNRS): A convenient clinical score for TMN risk assessment at presentation in adult patients (pts) with cancer.
Authors: Singh Abhay , Herr Megan , Mishra Rahul , Karia Rusina , Hahn Theresa , Thota Swapna 
Published: June 2024

11164 Background: tMNs are rare, albeit serious complication in cancer survivors. A tMN risk prediction model is currently not available, therefore we leveraged clinical information and history in a large population-claims database to devise the first tMN risk prediction model in adult cancer survivors. Methods: SEER-Medicare was used to analyze 970,390 adults aged 66-84 diagnosed with first primary cancer (FPC) from 2000-2011 (with follow-up through 2015), who survived ≥1 year. Medicare claims data classified individuals with a priori identified conditions. We focused on prostate, GI, breast, lung, and bladder (n=830,468) FPCs to develop a tMN risk prediction model. The population was divided into training and validation cohorts. Χ2 test identified risk factors associated with tMN. The tMN risk score (TMNRS) was created as a simple arithmetic sum of independent predictors of tMN weighted according to the adjusted odds ratio from logistic regression analysis. Pts were categorized into risk groups (Table) based on their TMNRS, which were tested in the validation cohort. Model performance was evaluated using ROC and c-statistics. Results: 87-96% of tMN developed within the first 10 years of FPC. Predictors of tMN included history of autoimmunity, infections, cardiovascular disease, granulocyte-colony stimulating factor, FPC stage, chemoradiotherapy exposure, age at FPC diagnosis, and sex. Training analysis distinguished survivors into distinct risk groups (table) with 10-year incidence of tMN ranging from 0.3% to 1.5% (prostate), 0.04% to 1.1% (GI), 0.2% to 1.4% (breast), 0.1% to 1.2% (lung) and 0.1% to 1.4% (bladder). The table summarizes the incidence of tMN and by risk category for each of the FPCs. After validation, the c-statistic ranged from 0.62-0.68. Conclusions: We utilized the largest SEER-Medicare cohort to date to develop a tMN risk model. The TMNRS captures several novel predictors and can be readily used in the clinic. This easy-to-use tool distinguishes cancer survivors into clinically relevant groups at risk of tMN development. This study lays the framework for screening and monitoring of pts at high risk of tMN. In future, we will leverage increasingly available molecular data to improve prediction performance of the model. Web-based calculator to be published with the manuscript/available at time of presentation. [Table: see text]