bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of health insurance type on time to breast cancer diagnosis and treatment among members of a large national payor.
Authors: Reddy Shirisha , Byrd Brooke , Craig Kelly , Zaleski Amanda , Rutter Cliff , McKeever Shannon , Bhandari Meghana , Dalton Karla , Altieri-Alger Leah , Verbrugge Dorothea J. , Avalos-Reyes Elisea , Johnson Kjel Andrew , Brito Rogelio 
Published: June 2024

e23049 Background: Delays in breast cancer diagnosis and treatment can decrease early screening benefits. This study investigates the relationship between health insurance type and time from cancer screening to biopsy and biopsy to treatment initiation in members of a national health plan diagnosed with breast cancer. Methods: De-identified administrative records of Medicare, Medicaid and Commercial fully insured (C-FI) members with a claim for breast cancer between January 2020 and December 2022 were retrospectively analyzed. Poisson regression modeling determined duration (days) from screening to biopsy and biopsy to treatment initiation by insurance type group controlling for covariates. Between-group differences in duration were estimated by exponentiating the model estimate and converting to a percentage change, which was then applied to the mean days to event. P< 0.05 was considered significant. Results: 29,731 members (C-FI: 5,256; Medicare: 22,304; Medicaid: 2,171) with a diagnosis of breast cancer were evaluated. Mean duration from screening to biopsy was 21.5 days (95% confidence interval [CI]: 20.9-22.0). Insurance type was associated with time from screening to biopsy. Compared to C-FI members, Medicaid members experienced a longer duration between screening and biopsy by +12.6 days (95% CI: 11.7-13.6; P< 0.0001). Compared to C-FI members, Medicare members received biopsies 3.4 days sooner (95% CI: 3.0-3.8; P< 0.0001). Mean duration from biopsy to treatment was 35.4 days (95% CI: 34.9-35.9) with similar differences by insurance type. Compared to C-Fl members, Medicaid members experienced a longer duration between biopsy and treatment by +7.9 days (95% CI: 6.9-9.0; P< 0.0001). Compared to C-FI, Medicare members received treatment 3.6 days sooner (95% CI: 3.0-4.1; P< 0.0001). Conclusions: Health insurance type appears to impact time from breast cancer screening to biopsy and treatment initiation. Medicaid members may experience longer duration for both time from screening to biopsy and biopsy to treatment. Future studies will explore if these variations translate to clinically meaningful health outcomes and identify opportunities to provide additional support for individuals experiencing breast cancer.
Economic analysis of combined multi-cancer detection blood test and usual care.
Authors: Dong Liangqing , Shi Yezhen , Zhao Jing , Gao Qiang 
Published: June 2024

e23055 Background: A previous multi-cancer detection blood test (MCDBT) in six prevalent and deadly cancers including colorectal, esophageal, liver, lung, ovarian, and pancreatic cancers, has been reported to decrease late-stage incidence and increase 5-year survival rate. However, the economic cost-effectiveness of integrating the MCDBT with usual care and the factors influencing it have not been investigated. Methods: An interception model was utilized to estimate the stage distribution at the time of cancer diagnosis, while a decision-tree model was developed to assess the clinical and economic outcomes of annual MCDBT for individuals aged 50 to 79 in the United States. The performance metrics for the MCDBT were based on the findings of a previous study called THUNDER. The incidence data were derived from the Surveillance, Epidemiology, and End Results Program (SEER), and the associated costs were obtained from SEER-Medicare. Other input data was estimated based on information available in the published literature. Results: In addition to the usual care, the integration of the MCDBT resulted in a shift of 27.9% in cancer cases from stage III-IV to stage I-II, which led to a decrease in per-cancer treatment cost by $5971 and an increase in quality-adjusted life-years by 0.10 per cancer case. The major factors that influenced the incremental cost-effectiveness ratio (ICER) included price, incidence, specificity, and sensitivity. The MCDBT with a price less than $800 showed cost-effectiveness with an ICER below three times the per capita GDP of the United States in the average-risk population. In a high-risk population with the incidence two-fold higher than the average-risk population, the ICER decreased by 58.3%. When compared the influence of specificity and sensitivity on the ICER of the MCDBT, a 5% increase in specificity resulted a decrease in ICER by 48.8%, while a 5% increase in sensitivity only reduced the ICER by 12.7%, suggesting the importance of high specificity in MCDBT. Conclusions: The MCDBT with a price less than $800 showed cost-effectiveness in the detection of colorectal, esophageal, liver, lung, ovarian, and pancreatic cancers. Price, incidence of the intended-use population, specificity and sensitivity were the major factors that influenced the cost-effectiveness.
Adherence for members taking oral oncolytic agents undergoing dose modification strategies.
Authors: Barnett Timothy , Rutter Cliff , Zaidi Shehla , Avalos-Reyes Elisea , McAuliff Kelly , Shah Dipti , Grover Rashmi , Feczko Lucia , Cavers William , Johnson Kjel Andrew 
Published: June 2024

e23058 Background: The use of oral oncolytic agents has transformed oncology care. Previous studies have reported that patient, treatment, and health system-related factors may influence adherence rates in patients prescribed oral oncolytic agents. The purpose of this study is to assess adherence rates in members of a large national pharmacy benefit manager taking oral oncolytic agents who experienced a modification to their dosing regimen. Methods: Adult members receiving palbociclib, abemaciclib, ribociclib, axitinib, lenvatinib, or cabozantinib between 01/01/2021 and 12/31/2022 were eligible for the study. Members who did not maintain continuous eligibility for 180 days prior to and 2 years after the first fill in the study period were excluded. Members were stratified by presence of dose modification, defined by a change in daily dose from one prescription to the next. Adherence was assessed via the proportion of days covered (PDC) which is the total days with medication coverage divided by the number of days between the index fill and exhaust of the final fill in the study period. Optimal adherence was defined as PDC ≥ 0.85. Standard statistical tests for continuous and categorical variables were utilized. Logistic regression was performed with the endpoint of optimal adherence. P values < 0.05 are significant. Results: 13,641 members were included in the final analysis, with 7,093 (52%) experiencing a modification to their dosing regimen during the study period. Several significant differences in sociodemographic variables were present in this study with members experiencing a dose modification being older (mean [standard deviation (SD)]: 65.7 [11.9] vs. 64.9 [13.0] yr; p < 0.001), more likely to be male (23.3% vs. 15.0%; p < 0.001), more likely to reside in high socioeconomic status (SES) regions (23.7% vs. 21.5%; p = 0.005) and more likely to receive tyrosine kinase inhibitors (TKIs) (37.6% vs. 23.6%; p < 0.001). Adherence was high overall with 74.6% of members achieving a PDC ≥ 0.85; however, members with dose modifications were less likely to be adherent (69.7% vs. 80.0%; p < 0.001). Holding other confounders constant, having a dose modification was associated with a decreased likelihood of adherence (Odds Ratio [95% Confidence Interval]: 0.6 [0.55-0.65]; p < 0.001). Conclusions: Dose modification was associated with significant decreases in adherence to oral oncolytic medications. Interventions designed to minimize dose modifications or to provide additional member support during a dose modification may optimize oral oncolytic adherence.
Correlation of cost in teaching hospital with outcomes in patients with cardiac myxoma: A retrospective study using the national in-patient data sample (NIS).
Authors: Chapiolkina Volha , Perez Esmirna , Guevara-Rodriguez Nehemias Antonio , Ghimire Manoj , Ghimire Kalpana , Olazagasti Coral 
Published: June 2024

e23062 Background: Cardiac myxoma (CM) is a rare cancer, benign but functionally malignant. It is the most common cardiac tumor and is more frequent in females in North America and Europe. Mortality has been associated with cardiac burden complications and the resolving capacity of the medical center to diagnose and treat these complications. Methods: A retrospective cohort analysis focused on adults admitted to hospitals between 2016 and 2020 with a primary diagnosis of CM. Data for this study were obtained from the NIS Database. The primary outcome was to determine if higher cost in teaching hospitals has an impact on mortality outcomes compared with non-teaching teaching hospitals. We looked at sociodemographic characteristics, length of stay (LoS), and complications as secondary outcomes. Hypothesis testing for categorical variables was tested with Chi-Square. Continuous variables were tested with a Student t-test. Statistical significance was defined as a two-tailed P value of < 0.05. Results: A total of 3,744 patients met inclusion criteria: 3014 were within teaching hospitals (TH), and 730 were within no-teaching hospitals (NTH). The median age was similar in both settings: 64 years in TH and 68 years in NTH (p < 0.001). LoS was higher in TH, 7.6 days, vs. NTH, 6.3 days (p = 0.05). Hospitalization costs were higher in TH, for a mean of $156,658 than in NTH, for a mean of $109,328 (p < 0.001). Most patients were females, 1850 in TH and 405 in NTH (p = 0.24). Mortality was higher in TH 75 vs. NTH 45 (p = 0.02). The population was composed of mostly White patients (68% in TH vs. 73% in NTH), followed by Back (14% in TH vs. 9% in NTH), Hispanics (11% in TH vs. 9% in NTH), Asian (3% in TH vs. 6% in NTH) and Native American patients (5% in TH vs. 0% in NTH) (p = 0.22). Patients were located mainly in the south region (39% in TH vs. 43% in NTH), followed by a similar distribution between the West (20% in TH vs. 27% in NTH), Central (23% in TH vs. 20% in NTH) and East regions (20% in TH vs. 10% in NTH) (p = 0.02). The most frequent payer was Medicare, 56% in TH vs 64% in NTH and private insurance, 28% in TH vs 24% in NTH (p < 0.001). Cardiac pathologies were the most frequent comorbidities: Congestive Heart Failure (p = 0.39), Cardiovascular disease (p = 0.18), hypertension (p = 0.1), and coronary artery disease (p = 0.44). The most common complications were cardiovascular, as demonstrated in previous studies. Conclusions: Cardiac Myxoma is a benign tumor with fatal severe complications that affect the more elderly female white population. Our study revealed a lack of significance between the outcome and the type of hospital in which patients received treatment. Similarly, mortality was not found to be driven by sociodemographic characteristics in our analysis.
Assessing the impact of unmeasured confounding in external control arms via tipping point analyses.
Authors: Yin Xiang , Stuart Elizabeth , Burcu Mehmet , Stewart Mark , Lamont Elizabeth B. , Davi Ruthanna 
Published: June 2024

e23065 Background: Estimates of the comparative efficacy of new therapies from single-arm settings can be obtained in advance of RCTs through use of external control arms (ECAs).[1] ECAs are collections of patients with the index disease who were treated outside of the single-arm trial, whose measured baseline attributes are matched to the single-arm trial patients and whose outcomes are compared to trial patients’ to estimate comparative efficacy. Without randomization, observed treatment-outcome associations may be confounded by unmeasured patient attributes. Applying established statistical methods, we estimate the magnitude and prevalence of unmeasured confounding required to move an apparently favorable hazard ratio (HR) to the “tipping point” where the new drug is no longer associated with a favorable survival statistically or clinically. Methods: Studying previously reported patients with multiple myeloma treated with an experimental therapy in a clinical trial (N = 290) and patients treated with standard of care therapy from a rigorously matched ECA (N = 290), we applied the method of Lin et al. to adjust the observed treatment effect (HR and 95% CIs) for overall survival to reflect the impact of a (set of) unmeasured confounder(s).[1,2] Lin’s formula incorporates both the unmeasured confounder’s theoretical association with mortality and its prevalence according to treatment group (i.e., single-arm trial vs. ECA). Results: The observed treatment effect for the single-arm trial treated vs. ECA patients was HR 0.76 (95% CI 0.63-0.91). We estimated the impact of an unmeasured confounder (where HR for overall survival of those patients with and without the confounder is set to 1.5) by its prevalence in each group. When the prevalence of the unmeasured confounder is balanced across groups there is no change in the observed treatment effect. When the presence of the confounder is 70% for ECA patients and absent in the trial patients, the clinical tipping point occurs with loss of the favorable HR (i.e., HR 1.02, 95% CI: 0.85-1.23). Conclusions: While novel analytic methods like ECAs have the potential to accelerate drug development, the lack of randomization raises concern for potential unmeasured confounding. Applying Lin’s method, we illustrate that the impact of unmeasured confounding on HR estimates from a single-arm trial vs.an ECA is a function of both the association with mortality and asymmetries in prevalence. Consistency in the efficacy conclusion for all clinically tenable assumptions indicates a qualitatively reliable conclusion. Friends of Cancer Research whitepaper (2019): available online at https://www.focr.org/sites/default/files/Panel-1_External_Control_Arms2019AM.pdf. Lin D, Psaty B, Kronmal R. Assessing the sensitivity of regression results to unmeasured confounders in observational studies. Biometrics.1998; 54:948–963.
Epidemiology of rare endocrine tumors 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

e23069 Background: Despite that thyroid and adrenal malignancies compose the vast majority of endocrine tumors, several other tumors could arise with significant resultant morbidity and mortality. Given the rarity of these tumors, thorough evaluation of the epidemiological features is of consequential significance in the diagnosis and management especially in the Middle East and Middle Eastern populations where adequate experience in such rare tumors is immensely limited. Methods: Extensive data on various endocrine tumors, other than thyroid and adrenal, diagnosed in patients from different nationalities residing in Jordan during the period of 2000-2018 were retrieved from the national institutionalized reporting body of cancer epidemiology in Jordan, the Jordan Cancer Registry. A total of 34 patients were included in the comprehensive epidemiological analysis performed to establish the epidemiological characteristics of these rare endocrine tumors. Results: A total of 34 patients with a mean age of 43.1 ± 18 years old with a female predominance of 64.7% have been enrolled. 11.8% of the patients were smokers at the time of diagnosis. Pituitary gland tumors were the most commonly encountered, 52.9%, followed by parathyroid gland malignancies reported in 32.4% of the patients, and craniopharyngioma in 14.7% of the patients. 29.4% of the patients had localized malignancy. There is a statistically nonsignificant increase in the crude incidence of these endocrine tumors with a crude incidence estimated effect of 0.001 (P-value = 0.21). Conclusions: Jordan has witnessed over the 18 years a range of rare endocrine tumors, mostly involving the pituitary gland. These rare endocrine tumors impose an unpredictable pattern in presentation and outcomes, and thus the determination of these epidemiological features will enable targeted diagnosis and management interventions.
Association of social determinant of health (SDOH) with clinical outcomes in patients with cancer: Opioid use, emergency admission, anxiety, depression, and length of hospital stays.
Authors: Poolakkad Sankaran Satheesh kumar , Epstein Joel Brian , Mohan Minu , Alam Naheed , Pili Roberto 
Published: June 2024

e23072 Background: As cancer patients are overburdened by disease, treatment, access to care, and other demographic factors, the obstacles become increasingly significant with SDOH. Patients hospitalized in the United States in 2017 for the treatment of prostate (PC), breast (BC), and lung (LC) cancer were evaluated to characterize further and contrast variations between SDOH and clinical outcomes. Methods: We utilized the generalized linear models to assess the association between homelessness and problem-related living alone (PrbLA) and clinical outcomes–– opioid abuse/long-term use, anxiety and depression, and burden of illness (length of stay) while controlling for patients’ characteristics. Results: In the study among PC, there were 425 homeless, 355 PrbLA; BC, 320 homeless and 225 PrbLA; LC, 1345 homeless and 820 PrbLA. In the adjusted analysis, PC homelessness was significantly associated with anxiety and depression (5.15, 95%CI: 3.17-8.35); emergency admission (5.57; 95%CI: 2.63-11.82); opioid abuse (3.75,95%CI: 1.27-11.13) and longer LOS, unadjusted (2.49; 95%CI: 1.58-3.92), adjusted analysis (1.96; 95%CI: 1.03-3.74). These findings were comparable in the BC and LC cohorts. Further in the adjusted analysis, PC patients with PrbLA were associated with higher combined anxiety and depression, adjusted (2.7, 95%CI: 1.64-4.46); emergency admission, adjusted (5.86; 95%CI: 2.66-12.91); opioid long-term use, adjusted (3.74,95%CI: 1.02-6.88) and longer LOS, adjusted analysis (1.44; 95%CI: 1.11-1.88). These findings were comparable in the BC cohort. In the LC cohort, when stratified to females, the PrbLA was associated with longer LOS (1.29; 95%CI: 1.02-1.63). In all cancer cohorts, when compared to Whites, SDOH was associated with poor outcomes––Blacks had a higher burden of illness. And when compared to Whites, Hispanics, Asians, and Others were associated with lesser opioid abuse among all cancer cohorts with homelessness. Conclusions: According to this study, PC, BC, and LC patients with poor SDOH presented with the worst clinical outcomes, including higher opioid abuse, emergency admission, anxiety and depression, and longer LOS in the hospital. The findings of this study highlight a vacuum in the literature, and the recommendations stress the value of social support for cancer patients in achieving a better prognosis and quality of life.
Recent trends in incidence, survival and mortality of female breast in the US: A Surveillance, Epidemiology, and End Results (SEER) database study 2010-2020.
Authors: Asif Samia , Kesireddy Meghana 
Published: June 2024

e23078 Background: We examined epidemiological trends and patient characteristics including age, race, incidence and survival in female breast cancer (BC) using the updated largest population-based cancer registry in the US. Methods: Female patients diagnosed with breast cancer between 2010-2020 were identified in SEER registries. We incorporated SEER 22 registries to calculate incidence, race, disease characteristics and overall survival. Results: Incidence Rate (IR) for BC has been increasing by 0.4%/year and mortality rates (MR) have declined 1.3%/year during 2010-2020 for all patients. 5-&10-year overall survival (OS) has increased by 0.1 and 0.2% respectively. For ages < 50 years,IR increased by 0.9% vs 0.4% for those 65 and above. No statistically significant change in IR was noted for ages 50-64y. For ages < 50 and between 50-64y, MR overall decreased by 1.4%/y each vs by 1.1%/y for those 65+. However, no statistically significant change in MR was noted for women < 50y between 2016-2020. IR increased by 1.6%/year in Asian/Pacific Islanders (API), 1.1%/y in Hispanics (H),0.6% in Blacks (B) and 0.4% in Non-Hispanic White (NHW) and. MR declined 1.5%/y in B, 1.2%/y NHW, 1% H and by 0.3% in API.IR for HR+/HER2- BC increased by 1.9%. No statistically significant change in IR was noted for triple negative or HER2+ only BC. IR for HR+/HER2+ BC increased overall during this time period by 1.4%; however, IR increased by 3.6% between 2010-2016 and decreased by 2.9% after 2016. 5y-OS was 91% in 2015 (CI 90.7-91.3) for all women, improved from 89.7% in 2010 (CI 89.4-90.0). 5yOS was 90.7% vs 91.3% vs 91.0% for < 50, 50-64 and 65+ age groups. When compared to 2010 and 2005, 5yOS was consistently improved across all age groups. 5yOS in B was 82.5% (CI 81.6-83.4) vs 92.1% (CI 91.8-92.5) in NHW. This discrepancy existed across all age groups: for < 50, 50-64 and 65+y, 91.6 vs 92.5 vs 92.1% for W women vs 82.7 vs 82.9 vs 82.0% for their B counterparts. 5yOS for localized, regional and distant disease at diagnosis for all women was 99.2%, 86.7% and 31.5%. 5yOS for B vs W females was 95.9 vs 99.7% localized, 78.3 vs 88% regional and 23.4 vs 33.0% for distant disease. Conclusions: Epidemiological trends show improved OS in BC among all groups. B females and patients with advanced stage have worse outcomes. Greater increase in IR was noted for women < 50 years of age. Greater IR increase was noted in H and API women but decline in MR was smallest in these women. IR for HR/HER2 + BC increased initially followed by a decline. 5r survival in B women was lower compared to NHW across all age groups. 5y survival for B women was worse, irrespective of stage at diagnosis. We hypothesize underlying disease biology may be a potential factor for worse outcome in B women.