bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical outcomes for non-small cell lung carcinoma by race and surgical facility types in the United States.
Authors: Singh Aditi , Nelson Cindy , Abdalla Ahmed 
Published: June 2024

11167 Background: Successful outcomes of surgical treatment of cancer requires expertise and high-quality supportive services for surgical care. Previous studies have shown that case volume and availability of other in-house supportive services affect surgical outcomes. Latest studies have shown that this gap has now significantly reduced. Issues related to access, availability of funding for latest technologies and continuous medical education still exist and likely still impact the surgical outcomes. The objective of the study is to understand the impact of surgical center related factors on survival outcomes for cancer patients based on race and other demographic features. Methods: We conducted a retrospective analysis of patients diagnosed with Stage I-III Non-small cell lung cancer (NSCLC) between 2004 to 2020 using the National Cancer Database (NCDB). Patients were divided into 4 cohorts of NCDB assigned facility type (Community Cancer Program, Comprehensive Community Cancer Program, Academic/Research Program, Integrated Network Cancer Program). Racial and other demographic data was analyzed for each of the facility types. Differences in categorical variables were evaluated using a Chi-square test. Results: 298,393 adenocarcinoma and 129,144 squamous cell carcinoma patients underwent surgery for NSCLC between 2004-2020. 326,798 patients with clinical stages I-III were selected for the analysis. Most surgeries were performed at the academic/research programs and comprehensive community programs. Utilization of each facility type was uniform across all races. The 30-day mortality rate was lowest for the academic/research programs (Community Cancer Program 3.1%, Comprehensive Community Cancer Program 2.6%, Academic/Research Program 1.8%, Integrated Network Cancer Program 2.3%; p=0.000). 30-day mortality rate was higher for American Indian, Aleutian, or Eskimo racial subgroups amongst all age-groups at all the surgical facility types especially for Stage IIIB NSCLC (White: 6%, Black: 3.4%, American Indian, Aleutian, or Eskimo: 14.3%, p=0.006). For each race, the 30-day mortality rate was better at the academic/research programs. Females had lower 30-day mortality for all racial subgroups. Having private insurance was associated with the lowest 30-day mortality rate. This was noted for all races across all the facility types. Lower income status was associated with higher mortality rates across all facility types. This difference was statistically significant for white patients. Majority of patients had less than 10 days of length of stay at all the surgical facility types. Conclusions: Outcomes of NSCLC surgery are significantly better at academic/research programs where a higher number of procedures are performed and access to latest surgical technologies is available. Short-term mortality rates are higher for American Indian, Aleutian, or Eskimo racial subgroup.
Effect of real-time data-driven physician engagement on appropriate precision oncology testing.
Authors: Liu Ying , McLeod Howard L. , Schreier Jeff , Bhogal Nirmala , Clark Jordan , Thompson Eve , Rompicherla Arun , Little Gemma , McKenna Joshua , Ismail Anjum , Varghese Sarah , Slifko Bethany Michelle 
Published: June 2024

11168 Background: Precision medicine is a paradigm shift in healthcare: 24% of all FDA approvals are precision medicines, with 67% of new approvals relying on companion or complementary testing or on diagnostics prior to clinical use. Yet a recent publication indicates that approximately 64% of potentially eligible patients could be lost due to various clinical practice gaps along patient journey (Sadik et al JCO 2022). Low prevalence biomarker testing is proven to be one of the critical determinants of missed therapy, potentially due to poor physician awareness. The increasingly advanced machine learning (ML) and natural language processing (NLP)-based ability to label, analyze, and segment data can be utilized to monitor and influence testing behavior in real-time. We hypothesize that a real-time data-driven physician-targeted digital engagement can increase biomarker testing rate and in turn enhance patient identification for precision therapies. Methods: Unstructured real-world, real-time biomarker testing reports were collected from 494 laboratories across the US. These testing reports were first curated, labeled and extracted via ML and NLP-based technologies to allow data analysis and reveal testing behavior. Suboptimal testing behavior was defined as no requisition of the selected novel biomarker as part of the diagnostic workups. Physicians who identified as having suboptimal testing behavior were selected as candidates to receive a personalized digital engagement over a 4-week period. The digital engagement's purpose was to raise clinical awareness towards the novel biomarker testing. The follow-up testing behavior was analyzed again over laboratory reports collected from 26-weeks’ time after the initial engagement. Results: 822 physicians were identified with suboptimal testing behavior and selected to receive 4 weeks' follow-up digital engagement. 271 out of 822 (33%) recipients were successfully engaged shown as open and read the digital communication. 42 (~15%) physicians reacted to the communications and ordered the new test at least once during this period. The initial 4 weeks' engagement was observed to be the most impactful, when 23 out of the 42 (~55%) physicians ordered the novel biomarker test for the first time.71 new therapy-eligible patients were identified via data-driven targeted physician digital engagement during the 26 weeks’ follow-up period. Conclusions: This study illustrates the value of data in influencing or reinforcing testing behaviors and emphasizes the value of data-driven physician-targeted digital engagement in addressing clinical practice gaps which in turn, drive patient identification to match potential eligible precision therapies.
New-onset atrial fibrillation, cardiovascular outcomes and all-cause mortality in patients with newly diagnosed cancer: A large population-based matched cohort study.
Authors: Mukherjee Diptasree , Walsh Declan , Alqahtani Saleh A , Krishnan Arunkumar 
Published: June 2024

11184 Background: Studies have shown an association between atrial fibrillation (AF) and cancer, but the relationship is incompletely studied. there is also a paucity of data regarding the specific association between cancer type and AF risk . Notably, the longitudinal associations of new-onset AF with adverse cardiovascular (ACV) outcomes in Newly Diagnosed Cancer Patients remain unclear. Thus, through a comprehensive nationwide population-based study, we assessed the associations between new-onset AF and subsequent risks of ACV events and all-cause mortality. Methods: This large retrospective cohort study was conducted using the TriNetX database and included adults (>18 years) with any new cancer diagnoses. We performed 1:1 propensity score matching (PSM) for demographics, BMI, nicotine dependence, comorbidities, cancer type, and medications to similar controls as cancer patients without AF. The primary outcome was new ACV events like heart failure (HF), major adverse cardiovascular events (MACE; coronary artery intervention myocardial infarction, or unstable angina), ischemic heart disease (IHD), and cerebrovascular events (CVE; cerebral infarction, carotid intervention, stroke, transient ischemic attack. The secondary outcome was all-cause mortality. Sensitivity analysis assessed statistical robustness. Hazard ratios (HR) were calculated to compare group outcomes. Results: Among the new diagnoses, 52,606 developed AF, and 374,959 remained AF free during the follow-up. After PSM, both cohorts (51,567 each) were well-matched. The mean follow-up duration was 4.8 (± 2.7) years. Among newly diagnosed cancer patients, those with incident AF had higher risk of MACE (HR 1.56; 95% CI 1.49–2.16), HF (HR 3.10; 95% CI 2.76–4.36), IHD (HR 1.68; 95% CI 1.41–2.01), CVE (HR 2.93; 95% CI 2.13–4.04), and all-cause mortality (HR 2.56; 95% CI 1.89–3.78) compared with those without incident AF. We noted a higher incidence rate during the initial months after the diagnosis of AF for both sexes. During the first year, the association with any ACV events (men: HR 2.78, 95% CI, 1.85–3.20; women: HR 1.81, 95% CI, 1.31–2.67) was more substantial than that following AF diagnosis for both sexes. New ‐onset AF was strongly associated with metastatic cancer. In sensitivity analysis, we excluded individuals with <1 year of follow-up results were consistent, and all statistically significant associations remained unchanged. Conclusions: cancer patients who developed AF had significantly higher risks of subsequent adverse cardiovascular events and greater all-cause mortality. AF was strongly associated with metastatic disease. Our findings highlight the importance of strategies for AF prevention to mitigate macrovascular complications in all newly diagnosed cancer patients.
Comparative analysis of actionable gene reporting in targeted panels versus comprehensive NGS testing for solid tumor samples.
Authors: Duong Chaugiang , Puentes Roisin , Montgomery Nathan , Lyle Derek , Lopez-Diaz Fernando J. 
Published: June 2024

11185 Background: The landscape of actionable genes significantly influences clinical decisions in cancer diagnosis, prognosis, and treatment planning. In a clinical context, the selection of NGS panels hinges on striking a balance among informative data, insurance coverage, and the preferences of patients and healthcare providers. Molecular pathology reference laboratories commonly employ large-scale next-generation sequencing (NGS) testing, curating smaller, disease-specific targeted panels. This study investigates the prevalence of unreported actionable genes in real-world clinical samples subjected to disease-specific panels. Methods: We analyzed SNV/InDel DNA variants in 795 clinical solid tumor samples using the Illumina TSO 500 platform for comprehensive NGS panel testing of 517 genes. Comprehensive NGS panel-tested samples were intersected with disease-specific targeted NGS panels for breast (54 genes), brain (62 genes), colorectal (36 genes), and lung (44 genes). An artificial filter was applied to align targeted panels with patient disease. Variants were classified based on pathogenicity, and benign variants were filtered out. Detected variants were assessed for actionable mutations as defined by the FDA recognized OncoKB actionable gene database criteria. Additionally, 1484 lung patient samples tested with a lung-specific targeted panel were de-identified and unmasked to the comprehensive NGS tumor profiling to investigate the prevalence of actionable alteration beyond those covered by the disease-specific panel. Results: The study revealed that 3.2% of breast, 0% of brain, 66.2% of colorectal, and 2.7% of lung samples had additional actionable mutations undisclosed by the targeted panels. The number of actionable genes beyond those included in the targeted panels were 14 for breast, 2 for brain, 25 for lung, and 41 for colorectal cancer. This underscores the importance of comprehensive testing to fully capture each patient tumor’s actionable mutation profile. Conclusions: Our findings detect masked actionable mutations in down-sampled targeted panels and highlight the need for comprehensive testing to accurately identify actionable mutations in various cancer types. Reporting actionable mutations can significantly influence clinical decision-making, emphasizing the importance of NGS test selection in routine molecular diagnostics as well as the impact of integrating comprehensive NGS testing.
Impact of chemotherapy-induced peripheral neuropathy permanence on patients' preference to discontinue chemotherapy.
Authors: Jun Yerial , Tao Xueting , Chen Ciao-Sin Chelsea , Griggs Jennifer J. , Kidwell Kelley M. , Hertz Daniel Louis 
Published: June 2024

12046 Background: Chemotherapy-induced peripheral neuropathy (CIPN) diminishes patients’ functional ability and quality of life; approximately 40% of patients experience CIPN symptoms 3 years after treatment. Due to the absence of effective CIPN treatments, ASCO guidelines recommend discontinuing chemotherapy in patients experiencing intolerable CIPN symptoms. Little is known about patient’s preference to continue or discontinue chemotherapy when experiencing CIPN, and whether the potential permanence of CIPN symptoms affects this decision. The objective of this prospective observational study was to determine the effect of CIPN symptom permanence on patients’ preference to discontinue chemotherapy. Methods: Patients receiving taxane and/or platinum chemotherapy for breast or colorectal cancer were enrolled in a prospective observational clinical study. Patients reported their CIPN severity using the EORTC CIPN20 patient-reported outcome questionnaire at the start of each treatment cycle. At the same time, patients were asked if they would prefer to continue or discontinue chemotherapy treatment under the hypothetical scenario that their current CIPN symptoms would be temporary or permanent. A generalized linear mixed effects model was used to determine the effect of CIPN severity, permanence, and other clinical variables on a patient’s decision to discontinue (vs. continue) chemotherapy treatment. Results: A total of 66 patients completed data collection at least one time, of whom 55 (83%) had breast cancer, 12 (18%) had metastatic disease, and 52 (79%) received a taxane. The odds a patient would prefer to discontinue chemotherapy treatment if their CIPN symptoms would be permanent (vs. temporary) were nearly 30 times greater (odds ratio (OR)=30.15, 95% confidence interval (CI): 15.73-57.79, p<0.001, Table). There was a statistical trend toward preferring to discontinue chemotherapy treatment as CIPN symptom severity increased (OR=1.09, 95% CI: 1.00-1.19, p=0.063). Conclusions: The potential for CIPN symptoms to be permanent has a huge effect on whether patients want to continue or discontinue chemotherapy treatment. Additional data is needed on the incidence and predictors of permanent CIPN. More importantly, shared decision-making tools that convey the risk of permanent CIPN, and the potential risk of discontinuing chemotherapy treatment, are needed to facilitate patient-centered treatment decisions so that each patient with cancer achieves their personal treatment goals. [Table: see text]
Physical activity and dexamethasone for cancer related fatigue: A preliminary placebo controlled randomized control trial.
Authors: Yennu Sriram , Valero Vicente , Smaglo Brandon George , Overman Michael J. , Dasari Arvind , Wolff Robert A. , Raghav Kanwal Pratap Singh , Barcenas Carlos Hernando , Busaidy Naifa Lamki , Fellman Bryan M. , Basen-Engquist Karen , Tripathy Debashish , Bruera Eduardo 
Published: June 2024

12050 Background: Despite high frequency and significant impact on quality of life, there are limited treatment options available for cancer related fatigue (CRF) in patients with advanced cancer. The primary aim of the study was to determine the feasibility (adherence, safety, and satisfaction) of the combination therapy, physical activity (PA) plus Dexamethasone (Dex); and PA plus placebo (Pl) for CRF. The secondary aim was to explore the effects of PA+Dex, and PA+Pl on CRF as assessed by Functional Assessment of Cancer Illness Therapy–fatigue (FACIT-F). Methods: In this phase 2, randomized, double blind, placebo controlled trial, patients with advanced cancer with CRF ≥ 4/10 on Edmonton Symptom Assessment Scale were eligible. Patients were randomized to standardized PA for 4 weeks plus either 4mg of Dex (PA+Dex arm), or Pl (PA+PL arm) BID for the first 7 days. Changes in FACIT-F scores from baseline to Day 8, and Day 29 were assessed. Other outcomes included change in quality-of-life scores. Results: A total of64 (89%) patients were evaluable. The median (IQR) changes in FACIT-F scores at Day 8 and Day 29 from baseline were 9 (2,16), P< 0.001; 5.75 (0,12.5), P=0.015 for PA+ Dex arm, and 3.5 (-2.13, 10), P=0.054; 6.50 (2.5, 15.5), P=0.006 for PA+ Pl arm respectively. Exploratory Linear Mixed Model (LMM) analysis showed significant treatment effect of PA +Dex, with treatment having improvement of 5.63 units for FACIT-F scores (95% Cl 1.74,9.52), P=0.005. Effect sizes for improvement of FACIT-F scores at Day 8 and Day 29 were -3.49, -2.43 in PA+Dex arm; and -1.93, -2.72 in PA+Pl arm, respectively. Effect sizes for change in fatigue related symptoms and quality of life scores as assessed by Patient-Reported Outcome Measurement Information System-Fatigue T-scores, Multidimensional Fatigue Symptom Inventory-Short Form total, and Functional Assessment of Cancer Therapy -General scores at Day 8, and Day 29 in PA+ Dex arm were 2.93 (P=0.005), 2.82 (P=0.005); 2.27 (P=0.023), 2.68 (P=0.007); -2.39 (P=0.017), -3.26 (P=0.001) respectively. Adherence to Dex and Pl were 91% and 92%, respectively, Satisfaction rates with PA+Dex and PA+Pl arms were 98% and 79%, respectively. There was no significant difference in grade ≥3 adverse events between the two arms (P = 0.36). Conclusions: Satisfaction, and tolerability to the combination therapy, and medication adherence was excellent.PA + Dex significantly improved CRF at day 8 and 29. The improvement was sustained 3 weeks after discontinuation of Dex. Further larger studies are justified. Clinical trial information: NCT03583255 .
Association of lung cancer-associated cachexia with the metastatic spread to pleura.
Authors: Sekula Bartosz , Szymanski Pawel , Konkel Magda , Zielińska Alicja , Altobelli Gioia , Szewczykowski Mikołaj , Naczk Edmund , Dróżka Magdalena , Rzyman Witold , Dziadziuszko Rafal , Skrzypski Marcin Tomasz 
Published: June 2024

12095 Background: Cancer-associated cachexia (CAC), a major contributor to mortality in patients with non-small cell lung cancer (NSCLC), is characterized by alterations in body composition. Here, we explore the associations between body composition changes and the pattern of lung cancer metastatic spread. Methods: Computer tomography (CT) images from cancer diagnosis and recurrence were used to quantify subcutaneous and visceral adipose tissue (SAT, VAT) and skeletal muscle (SKM) tissue areas at the 3rd lumbar vertebrae level, using an DAFS AI-based software, Voronoi Analytics, in 101 NSCLC pts, who relapsed after surgical treatment of the primary tumor at the Medical University of Gdansk Hospital. The decrease in SKM, SAT and VAT of more than 5% or 10% at cancer relapse was compared with the pattern of cancer recurrence. Results: The median time to recurrence after primary tumor resection was 1.6 years (0.4–6.4 years). There were 38% local or regional recurrences, 59% distant recurrences, and 13% second primary lung cancers. Among the cases with distant recurrence, there were 19% brain recurrences, 22% pleural metastases, 34% lung metastases, 17% bone metastases, and 11% cases of liver relapse. More than one site of distant recurrence occurred in 51 (50%) of patients. Loss of > 5% of SKM, SAT and VAT occurred in 61%, 33% and 41% respectively. Loss of >5% or >10% of SKM was associated with the pleural metastases at the time of cancer recurrence, ( P < 0.001). Median muscle loss was –11.6% for patients with pleural relapse and –5.3 % for patients with other metastatic locations ( P < 0.001). There were no significant associations between other body composition changes and the pattern of recurrences, tumor histology or age. Conclusions: NSCLC relapse to the pleura after surgical treatment of the primary tumor, appears to be associated with a decrease in the skeletal muscle compartment. This finding may inform the design of the future studies aiming to investigate molecular correlates of sarcopenia and cancer-associated cachexia.
Role of military physicians in cancer screening practices: The DEPISTmed study.
Authors: Helissey Carole , Peyrottes Arthur , Venturelli Maxence , Pautas Marie , Audisio Marie-Anne , Picchi Hugo , Le Roy Audrey , Barhli Aline , Schernberg Antoine 
Published: June 2024

e22502 Background: Cancer poses a significant health challenge within the military population, impacting both medical and economic aspects, as well as military operations. Despite the potential benefits of early cancer detection, adherence to organized and individual screenings remains below 50%. The pivotal role of military physicians, especially within military forces, in cancer prevention and screening is crucial.The main objective was to investigate the professional practices of military physicians in cancer screening, aiming to understand their perceptions, practices, and the role of screening in their daily routines. Methods: A prospective, observational, non-interventional cohort study was conducted, utilizing anonymous self-assessment questionnaires among military physicians practicing in army or joint military medical centers. Criteria for inclusion involved physicians engaged in patient care, including the performance of medical check-ups. Demographic data, perceptions, declared practices, and primary prevention measures were assessed through secure electronic questionnaires. Results: Between June 1, 2023, and September 30, 2023, 169 practitioners were included, with 51% were female. The median number of visits per practitioner was 400 (range 150-600). The study revealed a heightened concern among military physicians regarding cancer screening, particularly for breast, colon, and testicular cancers, with over 78% of practitioners expressing a significant level of concern (range: 59-90%). However, our investigation exposed disparities in clinical examinations and the prescription of additional tests, specifically within organized screenings among unit physicians. Less than 7% utilized recommendation sheets. Conclusions: Military physicians express a genuine concern for cancer screening, indicating the periodic medical check-up as an opportune moment for imparting screening information. The study highlights limitations such as the need for dedicated training, availability of materials, and optimizing patient care pathways. This research sheds light on the critical role of military physicians in cancer screening and provides insights into the challenges and opportunities for improving screening practices within military healthcare settings. The findings underscore the importance of targeted interventions to enhance adherence to screening guidelines and strengthen cancer prevention efforts within the military healthcare system.