bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breast cancer disparities among Hispanics in the US: Insights into healthcare access.
Authors: Roldan Estefania , James Ted A. , Schlam Ilana 
Published: May 2024

e13734 Background: Breast cancer (BC) is the most prevalent cancer and the second leading cause of cancer-related death in women in the US. Hispanics account for 19.1% of the US population, ranking as the second-largest racial/ethnic group, following the Non-Hispanics White (NHW) population. We aimed to assess the current BC characteristics and treatment patterns among Hispanics in the US. Methods: We conducted a retrospective cohort analysis utilizing the Surveillance, Epidemiology, and End Results Registry (SEER). Women newly diagnosed with breast cancer stages 1-3 between 2018 and 2020 were included. Bivariable analyses were conducted using two-sample Wilcoxon rank-sum and Chi2 square to evaluate delay in treatment, defined as a lapse of 3+ months between diagnosis and the initiation of treatment. Treatment encompassed neoadjuvant chemotherapy, radiation, or upfront surgery. Results: The study included 135,690 participants, among whom 16.5% (22,346) were Hispanic. Hispanic women were notably younger than their NHW counterparts (58 vs 65 years old). Most Hispanic and NHW patients resided in metropolitan areas and counties with an MHI exceeding $75,000. While both groups were predominantly diagnosed with Stage 1 IDC, it is noteworthy that a higher proportion of Hispanics tended to be diagnosed at more advanced stages (25.3% vs 17.9%). Additionally, Hispanic and NHW women were mostly diagnosed with HR+/HER2- BC (70.1% vs. 77.7%). Moreover, Hispanics had a higher percentage of HER2+ (15.2% vs. 11.5%) and TNBC (11.4% vs. 8.5%). Hispanics and NHW patients received mostly upfront surgery (74.3% vs. 83.1%), although a larger percentage of Hispanics were treated with NACT (20.8% vs 12.4%). Hispanic patients had a median time to treatment of 1.5 ± 1.34 months, while NHW patients had a shorter time of 1.22 ± 1.07 months, p-value <0.001. After adjusting for all variables, Hispanic women had 2.47 times the odds of experiencing a treatment delay compared to NHW women. Conclusions: This study reveals healthcare access disparities for Hispanic BC patients, emphasizing the need for targeted interventions. Personalized strategies in clinical practice and health policy are crucial for ensuring equitable outcomes for all. [Table: see text]
A comprehensive analysis of patient demographics and disparities in contemporary oncology clinical trials (2022-2023).
Authors: Reddy Neha K. , Williams Rikki , Khosla Atulya Aman , Menta Arjun , Subbiah Ishwaria M. , Gouda Mohamed Alaa , Subbiah Vivek 
Published: May 2024

e13748 Background: Overcoming disparities in cancer research is a major challenge that needs to be prioritized in clinical trials in oncology. In this study, we aimed to assess the current representation of patient demographics in phase 2 and 3 clinical trials in oncology to illuminate healthcare inequities during clinical trial recruitment. Methods: We identified published phase 2 and phase 3 oncology studies in five medical journals (New England Journal of Medicine, Journal of Clinical Oncology, Lancet, Lancet Oncology, and JAMA Oncology). We extracted data on patient demographics including sex, age, race, and ethnicity. We also extracted information on trial sponsorship (industry vs investigator initiated). Results: We included 381 articles published between 2022 and 2023 (108 investigator-initiated; 273 industry-sponsored). Details on age groups (<65 vs >65) were available in 149 studies (n=78,523 patients) including 47,192 (60.1%) < 65; and 31,331 (39.9%) >65. Data on gender were available in 373 studies (n=159,836 patients) including 73,308 (45.9%) males and 86,526 (54.1%) females (2 patients were listed as other). Race was reported in 214 studies (n=92,562) including 65,876 Caucasian (71.2%), 3,428 (3.7%) Black, 18,235 (19.7%) Asian, and 5,023 (5.4%) other/missing. Ethnicity data were available in 52 studies including 2,570 Hispanics (12.4%) and 18,234 non-Hispanics or unknown (87.6%). Conclusions: While there are efforts being made to diversify the recruitment of clinical trials, inequities in trial recruitment remains a major issue. Caucasian and younger patients represented the majority of patients, which may not be reflective of real-world practice. There is an important need to focus on increasing enrollment of underrepresented populations and understanding barriers to enrollment.
The physician oncology referral process and its effect on tumor board outcomes.
Authors: Oureilidis-DeVivo Barbara 
Published: May 2024

e13752 Background: Oncology settings are known for their hierarchical structure, with distinct status demarcations among professional occupational specialties. The physician oncology referral process, a critical aspect of cancer management, reflects this hierarchical nature. This process, initiated upon suspicion of cancer, entails sequential clinical evaluation and treatment by physicians in the following order: surgeons, medical oncologists, specialty physicians, and referral physicians like interventional radiologists and radiation oncologists. Those at the top of the hierarchy wield considerable influence over the oncology referral process, directing subsequent patient care. While several studies have criticized the effectiveness of cancer management teams, little attention has been given to the potential role of the referral process in reinforcing hierarchical structures within tumor boards, possibly undermining their intended goals. Methods: This qualitative, ethnographic study investigated the interplay between the physician oncology referral process and tumor board outcomes in oncology settings. Data spanning three years were collected from seven research hospitals in the United States and the United Kingdom, encompassing observations from 44 tumor boards and eighteen semi- and unstructured interviews. The principal investigator conducted an analysis and synthesis of the gathered data. Results: The ethnographic study revealed that the hierarchies observed in tumor boards align with and are influenced by the traditional oncology referral process. Group interactions and treatment deliberation outcomes were significantly affected by the social dynamics of hierarchy mirrored in the referral process, ultimately compromising the intended objectives of tumor boards. Surgeons and medical oncologists, who traditionally lead the referral process, tended to dominate tumor board meetings. In contrast, sub-specialties like interventional radiologists and radiation oncologists, positioned at the end of the referral process, were less engaged in deliberations and often overlooked for treatment referrals. The higher the position in the hierarchy and referral process, the more pronounced the tacit authority and ability to direct patient treatment. Conclusions: This study highlights the alignment of traditional oncology referral processes with tumor board dynamics, showcasing similar social and clinical impacts. Despite potential resentment cultivated by reinforced hierarchy in the referral process, tumor board members tend to acquiesce, accepting decisions even when they may not align with optimal patient care.
Investigation of racial disparities in hepatocellular carcinoma and rates of liver transplant: A SEER 2000-2020 study.
Authors: Nelson Nick , Hu Robert , Peace David 
Published: May 2024

e13754 Background: Hepatocellular carcinoma (HCC) most commonly occurs in patients with pre-established liver disease and is occurring with increasing incidence and mortality across the United States while disproportionately affecting all US racial/ethnic minority populations. Surgical resection or liver transplant is the preferred treatment for HCC if patient is a surgical candidate and offers the best chance to cure HCC. Previous literature analysis of HCC racial disparities using the Surveillance, Epidemiology, and End Results (SEER) database between the years 1998 and 2012 has been reported, however recent data has not yet been investigated to compare trends. Methods: The SEER database was used to identify 134,212 patients diagnosed with HCC between 2000 and 2020 in the US. Patients with HCC were identified using the ICD-0-3 primary site code C220 and histologic type codes 8170, 8172, 8173, 8174, and 8175. Patient race was categorized as White, Black, American Indian/Alaska Native, Asian or Pacific Islander, and Unknown based on SEER coding scheme. Racial disparities were then determined using chi-squared testing. Results: Patients with reported Unknown race or American Indian/Alaska Native had the greatest increase in proportion of new HCC diagnoses when comparing the years 2016-2020 to 2000-2005. Across all races, the average age at diagnosis was between 60-69 and males were more likely than females to be diagnosed with HCC. Those with Unknown race were more likely to present with Tumor grade I. American Indian/Alaskan Native patients were more likely to be reported as unstaged for HCC and also more likely to have surgery recommended, but not performed for an unknown reason. American Indian/Alaskan Native patients were less likely to receive liver transplant. Patients with Unknown race were more likely to be alive or dead of other cause and less likely to be dead from HCC diagnosis. When comparing this data to previously reported data from 1998-2012, there is an increase in proportion of patients having unstaged HCC especially in the American Indian/Alaskan Native cohort. Conclusions: Native American Indian/Alaskan Native patients continue to have significantly decreased rate of liver transplant (p<0.001) compared to White patients (24.24% vs 30.31%). Previous rates reported 4.4% vs 5.5%.
Barriers to receipt of oncological care at the community level.
Authors: Ramesh Nithya , Rajeshkumar Chitra Shanjeev Kumar , Durugu Satya , Thirumaran Rajesh 
Published: May 2024

e13756 Background: Though the field of Oncology is advancing at a rapid pace, there exist several barriers to the receipt of care in cancer patients that are known to affect outcomes. This study aims to describe the social, logistical, and financial barriers to healthcare faced by a diverse group of cancer patients in the community setting. Methods: A total of 40 patients receiving various kinds of oncological care (chemotherapy infusions, radiation therapy, immunotherapy, outpatient follow-up appointments) at a community hospital from 12/2023 to 01/2024 were anonymously surveyed using a standardized questionnaire. Responses were compiled and analyzed. Patients were divided into 2 groups that missed appointments (Group 1) and did not miss appointments (Group 2) during the study period. Results: While there was no difference between ethnic groups, women were less likely to miss their appointments. Patients who were not married, who lived in single-income households with annual income less than $32,048, had less reliable access to transportation and were more likely to miss appointments. Distance from the hospital and having a social worker assigned did not seem to affect compliance with scheduled appointments. Conclusions: Socioeconomic disparities and lack of family support remain significant barriers in the delivery of quality cancer care. These are seen to affect patient compliance and hence treatment outcomes. Hence adequate resources should be allocated to address the holistic needs of our patients and alleviate the above-mentioned barriers. [Table: see text]
Predicting fitness for chemotherapy in older adults with metastatic bladder cancer.
Authors: Russell Brian , Fein Daniel E.C. , Berg Stephanie A. , Gupta Shilpa , Rosenberg Jonathan E. , CHOUEIRI Toni K. , Bellmunt Joaquim 
Published: May 2024

e13761 Background: Guidelines advocate using comprehensive geriatric assessments (CGA) in older and frailer adults to optimize treatment recommendations, but it is unclear if genitourinary (GU) oncologists employ them. Through a national survey, this study aimed to evaluate techniques that providers use to predict fitness for chemotherapy in older adults with metastatic bladder cancer. Methods: This cross-sectional study surveyed US-based GU medical oncologists. Providers were included if they were identified as specializing in bladder cancer, had an accessible email address and worked at a National Cancer Institute-designated cancer center or an institution with an ACGME accredited hematology-oncology fellowship. Surveys were sent via email and collected in REDCap. The eleven-item survey consisted of multiple-choice questions and Likert scales evaluating use of geriatric assessments and other tools to predict chemotherapy tolerance. Results: There were 300 GU oncologists contacted, and 37.3% (n=112) completed the survey. Of respondents, 41 (36.6%) practiced in the Northeast with the remainder spread throughout the country. 51.8% (n=58) had practiced for ≥ 10 years, and 81.3% (n=91) had a panel composed primarily of patients ≥ 65-years-old. When making specific chemotherapeutic treatment recommendations, all providers consider a patients’ frailty. The majority (77.7%, n=87) do not use a specific age cut off, but rather, evaluate frailty on a case-by-case basis. Still, in predicting fitness for chemotherapy, 90.2% (n=101) almost never or never utilize a comprehensive geriatric assessment. Primary barriers centered on logistics including time constraints (71.4%, n=80), inadequate staffing (65.2%, n=73) and insufficient resources (33.9%, n=38). Beyond medical comorbidities, factors within a CGA that at least 50% of respondents consider important in predicting treatment tolerance include mobility (87.5%, n=98), social support (81.3%, n=91), cognitive function (73.2%, n=82) and nutritional status (71.4%, n=80) (Table). Conclusions: All surveyed providers believe frailty is important in predicting chemotherapy fitness, but the majority infrequently utilize CGAs in their evaluations. Highlighted barriers include time and resource constraints. While the CGA remains part of the standard of care in evaluating older adults for treatment, if a CGA cannot be performed, GU oncologists could consider focusing pre-treatment evaluation on the most important domains identified in this study: mobility, social support, cognitive function and nutritional status. [Table: see text]
Geriatric enrollment patterns in clinical trials at a National Cancer Institute.
Authors: Khazak Andre , Parsa Kian , Elias Evelyn , Liaw Bobby Chi-Hung 
Published: May 2024

e13762 Background: Despite the majority of new cancer diagnoses occurring within the geriatric population, there is a disproportionate rate of clinical trial enrollment within this population. Previous data has estimated enrollment rate to be 18.9% in treatment trials among all adult cancer patients at designated National Cancer Institute Cancer Centers. The objective of this study is to assess geriatric cancer patient clinical trial enrollment rates in a single National Cancer Institute and highlight inequities within cancer care delivery. Methods: We performed a retrospective review of the electronic health record and included patients with cancer ≥ 65 years of age who died at our institution between January 2020 and July 2022. We examined the relationship between cancer type, patient race/ethnic identity, and age and analyzed enrollment in clinical trials. Analyses were conducted using descriptive statistics. Results: Of 117 decedent records analyzed, 11 (9%) were enrolled in treatment clinical trials of which 5 (4.3%) identified as White, 4 (3.4%) Other, and 2 (1.7%) Hispanic. Among the 117 geriatric patient records reviewed, there were 21 Black patients (17.9%) of which 0 (0%) Black patients were enrolled in clinical trials. In comparing enrollment by malignancy type, 5 patients had a hematologic malignancy (leukemia, lymphoma, or multiple myeloma), 3 patients had a genitourinary malignancy, 1 patient had a pancreatic malignancy, 1 patient had an endometrial malignancy, and 1 patient had a breast malignancy. Among all patients analyzed, 37 patients (31.6%) had a hematologic malignancy and 80 patients (68.4%) had a solid tumor malignancy. The average age of enrolled patients was 73, consistent with the average age of all patients analyzed (73.78). Conclusions: Geriatric patients with cancer are disproportionately underrepresented in treatment clinical trials. The inequity is exacerbated when analyzing enrollment among minoritized patients. There was a greater proportion of clinical trial enrollment in patients with hematologic malignancies than solid tumor malignancies, however analysis in larger population samples is necessary. Additional research to identify barriers to clinical trials and methods of increasing geriatric enrollment, including the use of geriatric specific performance scales, is necessary to ensure equitable access and representation in clinical trials. While these results may be skewed in the setting of the COVID-19 pandemic and selection of a decedent population, further research into geriatric accessibility in clinical trials is paramount.
Fractionated external-beam radiation therapy in elderly patients.
Authors: Rao Sonia , Chava Samhitha , Chang-Halpenny Christine , Batth Sukhjeet Singh , Monson Jedidiah Mercer 
Published: May 2024

e13764 Background: To review the outcome of elderly patients treated with fractionated external-beam radiation therapy (RT) at a privately-owned, multi-disciplinary cancer center. Methods: From January 7, 2019, to August 22, 2023, 63 elderly patients were treated with fractionated RT at California Cancer Associates for Research and Excellence (“cCARE”), a privately-owned, multi-disciplinary cancer center in Fresno, California. The median age at the time of RT was 90 y/o (range, 85-98 y/o). Twenty-three patients were female and 40 were male. Forty-six patients identified as white and 17 as non-white. Treatment sites/histologies included primary lung 10, non-melanomatous skin 6, bone metastases 6, breast 5, esophagus 5, H&N 5, prostate 4, primary CNS 3, brain metastases 3, rectum 3, bladder 2, Merkel tumor 2, sarcoma 2, anus 1, liver 1, melanoma 1, multiple myeloma 1, NHL 1, pancreas 1 and stomach 1. Results: Thirty-two of the patients (51%) were treated with curative intent. The remaining 31 patients were treated for palliation. All patients were treated with fractionated RT. However, 4 patients also received a separate course of single-fraction RT. Twenty-seven patients received more than one course of RT. The median RT course was 10 fractions (range, 1-35 fractions). Most patients had previously been treated with systemic therapy. Nearly one third (31%) received systemic therapy concurrent with their RT. The majority of the patients (73%) completed their prescribed course(s) of RT. Many patients (61%) required one or more treatment breaks. The median duration of a treatment break was 1 day (range, 1-29 days). There were no grade 3 or higher RT toxicities recorded. The median follow-up since RT was 5 months (range, 1-59 months). Twenty-four patients have expired. The mediation duration from RT to death was 5 months (range, 1-32 months ). Of the remaining 39 patients, 92% were scored as clinically stable at the time of their last f/u visit. Conclusions: In our experience at cCARE, fractionated RT was administered to elderly patients and the majority completed their prescribed treatment courses. None of the patients in our review experienced clinically significant side effects (Grade 3 or higher) during their RT even in the cohort (31%) who were treated with concurrent systemic therapy. Clearly, careful patient selection and state-of-the-art RT administration is paramount. It is also highly advantageous for patients to be treated in a multi-disciplinary setting such as cCARE where seamless coordination of cancer care among radiation oncologists, medical oncologists and surgeons excels. A companion study is in process comparing the outcome of similarly matched elderly patients from our center who were treated with systemic therapy alone. We anxiously await the outcome of this vital comparison review.
Incidence of mortality in vulnerable and non-vulnerable older patients with cancer.
Authors: Rodriguez Calvillo Héctor Alejandro Alejandro , Hernandez Barajas David , Zayas Villanueva Omar Alejandro , Abundis Márquez Estefania Elizabeth , Urdiales Hidalgo Elias Román 
Published: May 2024

e13775 Background: Cancer most often affects older adults; 56% of all newly diagnosed cancer patients and 71% of deaths belong to this age group. Frail patients are at increased risk of unfavorable outcomes after Treatment. Methods: This cross-sectional study included adults older than ≥ 65 years who attended the Oncology department were included, with a diagnosis of a solid malignant neoplasm during March 2022-May 2023. Sociodemographic characteristics and characteristics of the disease were evaluated, and the G8 test was applied, a tool that identifies patients at risk of frailty (nutritional status, mobility, age, general health status, neuropsychological status, drugs used); a score ≤14 indicates that they are vulnerable. They were classified into two groups: group 1 (vulnerable) and group 2 (non-vulnerable). Telephone follow-up was performed at 12 and 24 weeks. We evaluated the incidence of mortality in both groups after oncological medical management. Results: Eighty-eight older adults were recruited, the majority were men (77.3%), and the mean age was 74.2 ± 6.71. Forty-seven patients (53.4%) were vulnerable (group 1), and 41 patients (46.6%) were non-vulnerable (group 2). Mortality at 12 weeks was evaluated: vulnerable (29.8%) vs. non-vulnerable (0%), and mortality at 24 weeks: vulnerable (46%) vs. non-vulnerable (4.9%). In both follow-ups, statistically significant results were obtained (<0.001). Conclusions: Vulnerable patients have a higher risk of unfavorable outcomes; their detection is essential to perform a comprehensive geriatric assessment and provide multidisciplinary treatment, improving the prognosis of their disease. [Table: see text]
Genetic Testing Utilization: Discrepancies Between Somatic and Germline Results in Patients With Cancer Reviewed at the UW Health Precision Medicine Molecular Tumor Board
Authors: Horn Isaac P. , Zakas Anna L. , Smith-Simmer Kelcy J. , Birkeland Laura E. , Sundstrom Rachel , Burkard Mark E. , Weiss Jennifer M. 
Published: May 2024

PURPOSE Somatic and germline testing are increasingly used to estimate risks for patients with cancer. Although both germline testing and somatic testing can identify genetic variants that could change a patient's care and eligible treatments, the aims of these tests and their technologies are fundamentally different and cannot be used interchangeably. This study examines the timing and results of somatic and germline genetic testing for patients with cancer at UW Health. METHODS Eight hundred and seventy-seven participants underwent somatic genetic testing, which was reviewed by the Precision Medicine Molecular Tumor Board (PMMTB). Patients were diagnosed with cancers, including breast, colorectal, endometrial, pancreatic, or ovarian cancer, and met National Comprehensive Cancer Network criteria for germline genetic testing. Germline testing details were collected by medical record review. RESULTS The results of this study found that only 310 patients (35%) had germline evaluation before PMMTB review. The percent of germline pathogenic/likely pathogenic variants identified in actionable genes was 28%. Most germline variants were identified in the BRCA1 (26%) and BRCA2 (28%) genes. In total, 65% (54/83) of germline variants were detected with both germline testing and somatic testing; however, 35% (29/83) of germline variants were not identified on somatic results. These results demonstrate the importance of combination germline and somatic testing. CONCLUSION This study highlights the differences in genetic testing types and demonstrates that conducting germline testing at earlier stages of diagnoses is necessary to identify potentially actionable and treatment-specific variants in patients with cancer.