bluuebunny/crossref_metadata_2025_split huggingface dataset:
Substance use among individuals with cancer: A US population-based cohort study.
Authors: Bakhtiar Mina , Lam Miranda B. 
Published: June 2024

e23133 Background: The prevalence of concurrent substance use or comorbid substance use disorder (SUD) among individuals with a cancer diagnosis, and their participation in substance use treatment, has not yet been described in a large US population-based cohort. Methods: A population-based cohort study was conducted using cross-sectional survey data collected by the National Survey on Drug Use & Health (NSDUH) between 2015-2022. Descriptive statistics were calculated to describe two populations: those with any kind of cancer diagnosis within the preceding 12 months and either comorbid SUD as defined by the Diagnostic and Statistical Manual of Mental Illness (DSM)-5 or concurrent use of any of the following substances: alcohol, marijuana, cocaine, crack, heroin, methamphetamines, or misuse of prescription drugs. Chi-square tests were conducted to describe associations with the demographic and geographic characteristics of these individuals. Results: Between 2015-2022, 432,764 individuals (53% female) completed the survey. A total of 2,547 respondents had a cancer diagnosis in the preceding 12 months; the most common cancer types were breast cancer (17.0%), non-melanoma skin cancers (16.2%), and prostate or testicular cancer (11.0%). Among this cohort, 1,664 (65%) reported concurrent alcohol use, 354 (14%) reported marijuana use, and 82 (3%) reported illicit use of other substances. Among those with an active cancer diagnosis in the preceding 12 months, 103 (4%) met DSM-5 criteria for a comorbid SUD based on survey responses. Among individuals with a past-year cancer diagnosis, there was a statistically significant association between concurrent substance use and income bracket (X2 = 92.67, p < 0.001), concurrent substance use and race (X2=46.12, p< 0.001), and between concurrent substance use and population density (X2= 7.05, p = 0.029). Zero respondents with cancer and either concurrent substance use or comorbid SUD received outpatient treatment for substance use in the preceding year, three (0.002%) received inpatient treatment, and seven (0.004%) participated in a support group. Among respondents with comorbid SUD, many reported being recently asked by a healthcare professional about their alcohol (83%) or drug use (67%), while only 1.9% reported recently receiving information from a healthcare professional about substance use treatment. Conclusions: There is overlap between the population with a cancer diagnosis and that with concurrent substance use or comorbid SUD. Based on population-level survey data, these individuals have low rates of participation in outpatient or inpatient substance treatment, and report that they do not often receive information about substance use treatment from healthcare professionals. Describing this population may inform how providers approach their unique healthcare needs.
Precision oncology and AI: The ACMA system for personalized treatment matching using real-world data.
Authors: Chen Hui , Xu Zanmei , Zhang Peng , Pang Fei , Chen Lijuan , Yuan Shaohua , Wang Kai 
Published: June 2024

e23134 Background: Precision oncology promises tailored cancer treatments, yet current methods often overlook individual patient variability. The AI-powered Case Matching Assistant (ACMA) system addresses this by utilizing real-world data (RWD) from over 100,000 clinical cases to personalize treatment strategies, considering genetic profiles, cancer types, treatment stages, and drug interactions. Methods: ACMA enhances the Large Language Model (LLM) with oncology-specific pretraining that encompasses both molecular and clinical data, ensuring a holistic understanding of patient profiles. It employs cosine similarity for multi-faceted case comparisons, integrating genetic, biomarker, and vital clinical information. Context-aware learning prompts fine-tune the LLM, generating recommendations that reflect the full spectrum of patient-specific data, from genetic variations to clinical histories and treatment responses, facilitating truly personalized treatment pathways. Results: Preliminary results show ACMA's tailored recommendations improve patient outcomes, with increased median survival rates and cost-effective treatment options. The system's 90% relevance match for clinical trial enrollment also expands access to novel therapies. In the absence of a standard treatment protocol for BRCA germline mutations in advanced lung cancer, ACMA provides crucial insights. For instance, a 36-year-old female with BRCA1 c.527del mutation achieved complete remission with a PFS of 38 months after a combination therapy trial. A 56-year-old male with a BRCA2 S1722Yfs*mutation saw partial remission and over 6 months PFS with olaparib. Another male patient, a smoker with concurrent BRCA2 G1712X and TP53 mutations, experienced partial remission following apatinib therapy. ACMA analyzed treatment data from similar genetic profiles and identified a targeted therapy that had shown efficacy in comparable cases. The oncologist used this information as a reference to adjust the treatment plan, resulting in a positive clinical outcome for the patient. This example underscores the potential of ACMA to provide actionable insights for personalized cancer care. Conclusions: Surpassing traditional single-feature matching, ACMA rapidly aligns multi-dimensional characteristics such as cancer type, disease stage, molecular data, and treatment phases. It customizes the interplay of these features with medical logic, delivering tailored outputs through the LLM. This approach offers an economical, convenient, and timely solution, setting a new benchmark in personalized oncology and establishing ACMA as a leader in the field. This distinctive advantage not only enhances patient outcomes but also establishes a formidable barrier to entry for competitors, solidifying ACMA's position at the forefront of oncology practice.
EHR documentation of cost discussions and financial interventions for a cohort of patients with advanced cancer: Findings from a retrospective chart review-based study.
Authors: Burkenroad Aaron , Anand Sidharth , D'Ambruoso Sarah F. , Glaspy John A. , Walling Anne M. 
Published: June 2024

e23150 Background: Financial Toxicity (FT), the adverse impact of high medical costs on quality of life, notably affects many oncology patients. In a prior initiative to improve quality of life for advanced cancer patients, a palliative care-trained nurse practitioner (PCNP) was embedded in an academic oncology practice. Patients completed the Edmonton Symptom Assessment System (ESAS) and Canadian Problem Checklist (CPC) to gauge physical symptoms, psychosocial issues, and financial concerns. However, the incidence of self-reported financial issues and electronic health record (EHR) documentation of cost discussions and interventions remain unclear for this patient group. Methods: The study included adult oncology patients with advanced cancer seen by the PCNP from January 1, 2020, to January 1, 2022. We assessed incidence of self-reported financial concerns via CPC checklists in this cohort. Ten charts underwent detailed manual review for evidence of cost discussions or referral to finance-related interventions for up to 1 year from the initial consult with the PCNP or until death. During the review, we identified keywords in documentation of cost discussions and finance-related interventions to create a keyword library. We iteratively compared the library to our reference standard manual chart review to ensure 100% sensitivity. We then employed this keyword library to evaluate the remaining charts. Descriptive statistics were employed to assess correlations between self-reported financial concerns, chart documentation of cost discussions or financial interventions, and patient demographics. Results: Out of 109 eligible patients, 71% (77) completed pre-visit questionnaires, with 30% (23) reporting financial issues. Of this group, 43% (10) died during the study period. Average follow-up was 5.0 months among the decedents. Among those reporting financial concerns, 65% (15) had documented cost discussions or financial assistance referrals in the EHR, involving physicians, social workers, and other clinic staff. Most interventions addressed medication costs and referrals to financial assistance as indicated. Patient demographics (age, sex, insurance type) showed no apparent association with chart documentation of cost discussions or financial assistance. Conclusions: We used retrospective chart review to evaluate the extent of documentation of cost discussions and finance-related intervention in a cohort of patients with advanced cancer. In our patient cohort, 30% self-reported financial concerns, a proportion consistent with previously reported incidence of FT among oncology patients. Notably, 35% of the patients with known financial concerns had no other relevant documentation in the EHR. More work is needed to establish best practices for systematic screening for FT and interventions to support patients.
Racial disparities in incidence and survival in renal cell carcinoma in adolescents and young adults (AYA).
Authors: Wasifuddin Mustafa , Uche Ifeanyi , Becerra Henry A. , Oluwadeyi Esther Yemisi , Lin Htet , Ilerhunmwuwa Nosakhare Paul 
Published: June 2024

e23153 Background: Renal cell carcinoma (RCC) has doubled in incidence over the past 50 years. Most cases are incidentally discovered. AYA cancer is defined as cancer in individuals 15 to 39 years. There is paucity of data in the literature on racial disparities in the incidence and survival outcomes of RCC in AYA. We aim to determine the influence of race on incidence and survival outcomes in AYA. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) 17 program were utilized to obtain annual percentage change (APC) of RCC from 2000-2020 for patients aged 15-39 years. Patient characteristics were expressed in proportions. Relative survival rate (RSR) was used to determine survival outcomes. The 5-year RSR was defined as the percentage of patients alive 5 years after the diagnosis of cancer. SEER*Stat software was used to determine the RSR. Results: We identified 8751 patients with RCC. A higher proportion of cases were males (57.9%) vs females (52.1%). Patients were predominantly non-hispanic whites (NHW, 54.7%), hispanics (24.9%), non-hispanic blacks (NHB, 11.4%), non-hispanic asian or pacific islander (NHAPI, 0.06%) & non-hispanic american indian/alaska native (NHAIAN, 0.01%). There was significant increase in RCC incidence (APC: 4.0%, CI: 3.0, 4.9). Incidence was higher in males (APC: 4.0, CI: 3.1, 5.0) vs females (APC: 3.9, CI: 2.8, 5.0). Incidence was highest in Hispanics (APC: 5.6%, CI: 4.4, 6.8), followed by NHW (APC: 4.1 % CI: 3.1, 5.2, -2.3), NHAPI (APC: 3.3%, CI: 1.2, 5.5) and NHB (APC: 1.5%, CI: 1.1, 2.0). The 5-year RSR was 79.7% (CI: 77.7, 81.6). Survival was greatest in females (RSR: 82.8, CI: 79.8, 85.4) vs males (RSR: 77.3%, CI: 74.4, 79.9). NHB had the lowest survival (RSR: 65.9%, CI: 60.2, 71.0) compared to NHW (RSR: 83.9%, CI: 81.3-86.2). Conclusions: In AYA, RCC incidence has increased; consistent with global trends. Significant racial disparity in incidence and survival exists. Survival in NHB remained poorer than other racial groups despite minimal increase in incidence. More studies are needed to explore the reasons for these racial differences to improve the outcomes among AYA patients. [Table: see text]
Evolution of quality of life (QoL) and symptom burden (SB) in patients receiving inpatient palliative care (PC) following one week of care in a specialized palliative care unit (PCU): A comparison of two groups, with one receiving specialized outpatient palliative care prior to admission.
Authors: Salm Hanna , Doberschütz Florian , Hallmann Franziska , Munzert Philipp , Rahm Johannes , Uhlig Sarah , Pink Daniel 
Published: June 2024

e23160 Background: This study sought to investigate changes in QoL and SB among PC Pt undergoing one week of inpatient care in a specialized PCU. The Pt population was stratified into two groups (Gp), with one Gp pretreated from pre-admission PC provided by an outpatient multidisciplinary PC team, while the other Gp did not receive such support prior to admission. Although the average duration of treatment at a PCU in Germany is 1-2 weeks, the question also arises as to whether a significant improvement in SB/QoL can be expected after just one week of PC in a PCU. Methods: PC Pt with various cancer entities were prospectively included in a non-randomized study. Pt in Gp 1 received outpatient specialized PC prior to admission, while Pt in Gp 2 did not. Over an 8-month period, we gathered data from one academic cancer center, utilizing the EORTC QLQ-C30, one of the most widely used Pt reported outcome (PRO) instruments to assess health-related QoL in cancer Pt. Pt completed the QLQ-C30 at T0 (admission) and T1 (day 7), enabling the assessment of potential changes in their QoL and SB over time. Results: A total of 103 pt (51.5% male) were enrolled (Gr 1: 42%, Gr 2: 58%). At T0, there were no significant differences regarding QLQ-C30 scores between Gp 1 and 2. Over the course of one week several significant and clinically relevant changes in QoL and SB were found: Emotional functioning demonstrated an uplift in both Gp (Gp 1: mean (M) 41.5 IQR 33 vs. 53.1 IQR 50, p 0.014, Gp 2: M 48.2 IQR 46 vs. 56.8 IQR 58, p 0.029), as did the global health status (Gp 1: M 20.7 IQR 17 vs. 36.2 IQR 33, p < 0.001, Gp 2: M 25.6 IQR 25 vs. 35.3 IQR 33, p < 0.001). Nausea and vomiting showed a reduction (Gp 1: M 29.9 IQR 17 vs. 6.8 IQR 0, p < 0.001, Gp 2: M 22.6 IQR 17 vs. 8.2 IQR 0, p < 0.001), along with a notable decline in pain (Gp 1: M 67.4 IQR 67 vs. 25.3 IQR 17, p < 0.001, Gp 2: M 73.1 IQR 83 vs. 29.7 IQR 17, p < 0.001). A decrease was observed in insomnia (Gp 1: M 63.6 IQR 67 vs. 27.6 IQR 33, p < 0.001, Gp 2: M 60.1 IQR 67 vs. 27.6 IQR 33, p < 0.001). There were no significant differences between Gp 1 and 2 in the extent of improvement in the various symptom scales from T0 to T1, except for cognitive functioning, where Gp 1 exhibited an increase while Gp 2 demonstrated a decrease (p 0.044). Conclusions: The findings of our study demonstrate that QoL and several symptoms prevalent in cancer Pt cared for in the PCU experienced significant enhancement over the span of just one week of PCU care. Both Gp, Pt receiving specialized outpatient PC prior to admission and those without, equally benefited from inpatient PC. All mentioned changes from T0 to T1 are considered not only significant, but clinically relevant.
Immunotherapy related patient-reported outcomes from five randomized controlled trials in patients with triple negative breast cancer: A systematic review.
Authors: Sha Carrie , Liu Marie , Goldberg Johanna , Norton Larry , Robson Mark E. , Zhi Iris 
Published: June 2024

e23167 Background: Immunotherapy (IO) has improved clinical outcomes in patients with early-stage Triple Negative Breast Cancer (TNBC) receiving neoadjuvant therapy and certain patient subsets in the metastatic setting. This study aims to evaluate IO-related Patient-Reported Outcomes (PRO) in patients older than 65 years. Methods: We searched Medline ALL (Ovid), Embase (Elsevier), Cochrane Central (Wiley), ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform. The searches combined terms reflecting (1) the immune checkpoint inhibitors atezolizumab, durvalumab, and pembrolizumab; (2) breast cancer; and (3) randomized controlled trials. Results were limited to items published in English from 2013 through September 2023. We excluded review articles and clinical trial records without results. Two independent reviewers (C.S. and M.L.) screened the studies using the systematic review management tool Covidence, and conflicts were resolved by a third reviewer (W.I.Z.). We included studies that reported on PRO in adults with TNBC receiving any of the three immunotherapies of interest. Results: Five publications composed of two peer-reviewed papers and three abstracts were identified, including 3878 total patients and 3184 with PRO. Three pembrolizumab studies had 2643 total patients (2056 with PRO) and two atezolizumab studies (IMPASSION 130, IMPASSION 031) had 1235 total patients (1128 with PRO). The PRO analysis in KEYNOTE 522 included 1145 patients in the neoadjuvant phase and 847 in the adjuvant phase. The PRO analysis in KEYNOTE 355 included total 847 patients and 317 with Combined Positive Score (CPS) ≥10. No study specified PRO data for patients older than 65 years. Baseline completion rates for all studies were > 80%. All studies used standardized PRO instruments, including the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC- QLQ C30) and its Breast Cancer Module (QLQ-BR23), the Functional Assessment of Cancer-Therapy-General (FACT-G GP5), and the EuroQol-5 Dimension (EQ-D5). All studies showed no statistical difference, or clinical meaningful decline in PRO endpoints between patients who received chemo with IO versus chemo with placebo, during and post treatment follow up. The PRO analysis from KEYNOTE 119, which included total 594 patients of which 187 had CPS ≥10, demonstrated that patients receiving single agent chemotherapy had worse PROs related to systemic therapy side effects and hair loss while the pembrolizumab group had decreased worry about future health. None included subgroup analysis by age, including patients older than 65 years. Conclusions: Our systematic review demonstrates that in both early and advanced TNBC, IO did not worsen PRO. Prospective and retrospective data in IO-related PRO in older patient population are needed.
The Progress Tracker Breast Cancer Registry: Feasibility of a longitudinal patient-led, patient-reported outcomes (PROM) registry.
Authors: Leduc Shaniah , Gibson Amanda Williams , Dean Michelle Liane , Carson Kimberly , Khan Omar Farooq , Howell Doris 
Published: June 2024

e23169 Background: A breast cancer diagnosis has the greatest disability-adjusted life years lost of all cancers and significant impact on physical, psychoemotional, social and overall global functioning. Directed by Breast Cancer Canada, a registered non-profit patient-led organization and data managed by the University of Calgary’s POET Program, PROgress Tracker uses a novel, peer-to-peer support model for recruitment, engagement and retention, and is the first national longitudinal and non-interventional PROMs registry. Our aim is to demonstrate the feasibility and potential of this registry in centering patient voice and lived experience to transform breast cancer management. Methods: PROgress Tracker, with 10-year enrollment goal of 50,000 Canadians with Stage 0-IV breast cancer, extends a series of validated PROMs (PROMIS, BREAST-Q, FACT-B, GAD, PHQ-9, COST-FACIT, ISI and ESASr-CA) via a digital platform every 3 months for up to 10 years. Dynamic customization of additional PROMs (PRO-CTCAE, BREAST-Q) based on patient and treatment-specific trigger questions assess evolving components of wellbeing, including financial stress, work life and adverse treatment effects. Results: Recruitment began in October 2023. 162 participants from all Canadian regions including remote/rural geographic areas have shared baseline demographic and clinical data including stage, genetic/molecular tumor markers, treatment type(s) and completed an initial series of PROMs. Comprehensive PROMs including sensitive topics (finances, sexuality, mental health) were completed with minimal missing data ( < 5%); 3-month follow-up surveys show a current retention rate of 57%. Preliminary analysis: median age of participants 54 yrs, 95% identify as Caucasian, and 57% are currently working. 46% reported financial stress (99% response rate); 63% reported ongoing symptoms requiring follow-up. 6% were BRCA+ and 19% triple negative, 7% experienced recurrence, 3% Stage IV, 75% received systemic and/or radiation therapy, 38% received targeted therapy. Conclusions: The lived experience of breast cancer is integral to patient-centred change in the era of precision/personalized medicine and is captured by PROgress Tracker using a diverse set of periodic PROMs to understand the evolution of global measures of wellbeing over time. Initial data indicates that this novel peer to peer model via digital administration of comprehensive and longitudinal PROMs is feasible. This initiative demonstrates attaining this scope of data is achievable, has interest and participation from the national breast cancer community and growing capacity to accrue important, real-time data to inform best practice and identify additional supports required for breast cancer care. While early feasibility is evident, further outreach and recruitment initiatives will ensure diversity of participants.
Unveiling impacts: A quality of life survey for individuals with a history or diagnosis of cancer.
Authors: Tinianov Stacey , Shanahan Kelly , Mason Ginny , Bachini Melinda , Horn Marcia K. , Hutcheson Laurie , Hayashi Joanne , Conneran Terri , Glenn Lesley Kailani , Thomsen Catherine 
Published: June 2024

e23179 Background: Cancer treatments, despite increasing effectiveness, involve significant short and long-term side effects profoundly impacting a person's quality of life (QoL). In response, Advocates for Collaborative Education, a global coalition of patient advocates, initiated an exempt, online survey to gather insights on the perceived QoL impact of cancer diagnosis and treatment. The effort sought to identify community priorities and hopes to guide improvements in supportive care. Methods: A comprehensive survey, developed by patients, survivors, and advocates, comprised six sections and 93 questions. Co-creation played a vital role in determining relevant categories, questions, and measurement scales to assess severity and impact of QoL challenges. The study requested demographic and cancer diagnosis data before inquiring about 17 treatment-related side effects, their perceived severity, preparation, unintended side effects of supportive care, and personal preferences for cancer-related information. Recruitment was conducted via social media. Results: The survey garnered responses from 515 individuals with a history of cancer and a wide range of demographic subsets, including age, race, stage of cancer, and treatment modalities. Survey respondents reported an average pre-diagnosis QoL score of 8.87 out of 10, which declined to a mean score of 6.41 post-diagnosis. Across all cancer types, physical well-being was a top priority for most respondents (51.5%), followed by emotional well-being (25.4%). Across a variety of side effects, unintended consequences of side effect treatments were highlighted, revealing complexities in supportive care. Detailed results for all categories and stratification by subsets of age, race, metastatic vs. early stage, treatment type, and others are available for presentation and publication purposes. Conclusions: This study highlights the significant negative impact of cancer treatment on an individual's QoL, addressing an underexplored area of cancer research. While managing treatment side effects is crucial, supportive therapies may introduce additional side effects, exacerbating an overall burden on patients. The collaborative survey development with patients and survivors represents a pivotal step, offering valuable insights for enhancing the well-being of individuals affected by cancer. [Table: see text]